American School of Professional Psychology at Argosy University, Orange County

Informed Consent Form



Please read this consent agreement carefully before agreeing to participate in this experiment



Title of the study: Subjective Difficulty of a Romantic Breakup as Mediated by Social Media Use



Purpose of the study: This research study is being conducted by Sara Salessi at American School of Professional Psychology at Argosy University, Orange County in order to learn about potential impacts of social media on recovery from a romantic break-up.



What you will do in this study: You will need to read and agree to this form giving the researcher permission to include you in the study. If you choose to participate, you will take an online survey that asks for some demographic information, and asks about how often you access your ex's social media profiles. The survey will also ask about various psychological symptoms you may be experiencing.



Time required: The survey will take about 15 minutes to complete



Risks: There are minimal risks for participation in this study, however, there is the potential for the survey to bring up negative memories or emotions. If you are experiencing emotional distress, you can reach a local help hotline at (877) 727-4747. You also have the right to withdraw from the study at any time with no repercussions.



Benefits: All participants will be entered into a raffle for a chance to win a $25 Visa gift card. Please e-mail the researcher at ssalessi@stu.argosy.edu to be entered in the raffle with the word "Survey" in the subject line. Otherwise, there are no direct benefits to participants. However, it is hoped that your participation will contribute to the research on social media and relationships. At the end of the study, you will receive a complete explanation of the research and its findings.



Confidentiality: The records of this study are confidential and your identity will remain protected. All surveys will be stored on the researcher's password-protected computer, and will be destroyed upon completion of the research.



Researcher contact and participant rights: If you have any further questions or concerns, please contact the researcher at ssalessi@stu.argosy.edu. For information on your rights in this experiment, you may contact Dr. Alina Gram, who is the supervisor of this project, at agram@argosy.edu. You may also contact the Dr. Diana Siganoff, who is the Chair of Argosy University, Southern California Institutional Review Board at 601 South Lewis Street, Orange, Ca 92868, 714-620-3625.



Before selecting "Next," please talk to the researcher to clarify anything on this form, or to discuss any concerns about participating in this study



Agreement: The purpose and nature of this research study has been explained to me by the researcher. I understand that I do not have to participate in this study and may end my participation at any time. By clicking "Next," I agree to these terms.



