Research Subject Consent Form
EEG, QEEG, sLORETA, GDV, Examination of “The Bars” Energetic Process Related to Electromagnetic Components of Behavior, Emotion and Anxiety and Depression

Principal Investigator: Terrie Hope

Purpose of Research

Purpose of this research is to examine the energetic process identified as “The BARS” related to brainwave activity, energy in the body. We will study whether it has any effect on brainwave activity or energy in the body. If there is an effect on brainwave activity or the body or does it affect
Specific areas of thought, emotion and stress are key points of interest in this study to determine whether there is any role or impact “The BARS” may have on any of these key components.
It is believed there are 32 points on the head, that when lightly touched will release the flow of energy relating to those points. We will examine whether the process “The BARS” has any effect on the components relating to these points, and whether they have an effect on thoughts, emotions and those related to anxiety and depression.
Your participation involves the following:

You will be asked to participate in the following:
Testing via Brainmapping (EEG recording) and GDV (Gas Discharge Visualization)
You will be asked to complete a questionnaire related to Anxiety and Depression
(Beck Depression Score and Beck Anxiety Inventory
You will receive a 90 minute session, “The BARS”. This one-time study visit will last about 3 hours.
You will receive a telephone follow-up interview -15 minutes maximum, 1 week after your session.

Testing:

Brainmapping
Brainmapping is a non-invasive process of measuring brainwave patterns commonly referred to as EEG. The information is then converted into a visual representation via computer program.
It will take 10 minutes to setup your EEG with the measuring device which will sit comfortably on your head, much like a protective bike helmet.
We will then take measurements and record 12 minutes of information;
4 minutes each: eyes open, eyes closed and brain on task (reading)

GDV
GDV (Gas Discharge Visualization) is a non-invasive measurement tool to identify energy in the body both physical and emotional. You will be asked to place your fingers, each individually on a camera lens, which will take a picture of your energy signature. This will be done twice, once for the physical component and once for the emotional component. The information is then converted to a picture representation via a computer program.

We will also be measuring the energy in the room during “The BARS” session.
As a participant you will be asked to lay on a massage table with a pillow under your head, and receive a 90 minute session of “The BARS”,. There will be additional pillows and blankets provided for your comfort.

Step by Step Process you will receive

Step 1: Complete the Forms:
Step 2: Gas Discharge Visualization (GDV) testing- 10 finger test with no filter to capture physical energy signature and then 10 finger test – with a filter to capture emotional energy signature
Step 3: Brainmapping – 12 minute baseline recordings; 4 minutes each eyes open, eyes closed and brain on task
Step 4:The energy of the room will be measured at the beginning of the process and continuously through the testing process
Step 5: As the Receiver of “The BARS” process you will be asked to receive this process for 90 minutes. We will provide additional pillows and blankets for your comfort.
Step 6: GDV post testing 10 finger test with no filter and then 10 finger test – with a filter
Step 7: Brain mapping post-test 4 minutes each – eyes open, eyes closed, on task (reading)
Step 8: Complete the Forms

Forms:
You will be asked to complete short forms, which will include:
– Beck Depression Form
– Beck Anxiety Form
– Your previous experience receiving this process
– Your handed preference, wear contacts and history of brain trauma e.g. head injury
– List any medication you are currently taking

Potential Benefits
The research will examine specific areas of thought, emotion and Anxiety and Depression. You may not receive any benefit from this process. If you do, we are not certain how you will benefit from “The BARS” session, and responses may vary from person to person, however, we hope you enjoy the experience.
The information we gather from this research will assist us to have a greater understanding of “The BARS” and any potential benefits of the process, including those relative to anxiety and depression

Risks and Discomforts

There is a possible risk of loss of confidentiality from participating in research. We will maintain your information as confidential as possible by using ID number instead of your name. All testing equipment is non-invasive, and the data is analyzed via computer programs. They do not involve x-rays, radiation or injections. DSI-24 dry sensor headgear used for collecting EEG, information is collected via the sensors touching your scalp. The device will monitor the amount of electrical activity at different points on your scalp. There is no sensation, electricity or any pain during this process

GDV testing requires you to put your fingers individually on a camera lens which will take an energetic profile both from a physical perspective and emotional perspective. The camera uses a small burst of energy (less than a millisecond) to take the energetic snapshot capture of each finger.

The equipment used to measure the energy in the room is attached to the GDV unit and simply receives information from the room. There is no contact with you whether you are a giver or receiver of the process “The BARS”.
The Sputnik equipment which is attached to the GDV unit receives information from the room. There is no contact with you, the receiver of the process..
There are no known risks to you regarding EEG Brainmapping. Only qualified and certified professionals will operate the Brainmapping equipment and procedures. Data collection with wireless recording does not present a risk and is less than that of using a cell phone.

Data and safety monitoring will be conducted by the Investigators throughout the process, and they will remain present in the room with you at all times. They will stop the process of recording EEG if requested by you. Should you wish to stop the process of the session of “The BARS”, you may do so at any time.

Protection and Confidentiality

We will not share your information with anyone outside the study team, except as required by law. Your identity (name) will not be revealed in any publication resulting from this study. To protect your identity you will be assigned an ID number. We will use this ID number for all study related forms including EEG, GDV recordings. The consent forms will be kept separate from the data files. No data with subject identifiers will be transferred over the internet. This data may be used for further research by the study team and will have no personal identification records.

During this research you may choose to be photographed or have audio or video recordings of the experience. The Audio and Video consent form included for your consent and choice. This will only be done with your approval and you will be aware when the pictures are being taken or when audio/ video recording is being done. The recording will be used for educational purposes, conferences and research data. However, during these recordings, your identity (name) will not be released but your photos and videos may be recognized by someone you know.

Voluntary Participation

Your participation in this research is entirely voluntary. Your alternative to participate is, to not participate. You may choose not to participate and you may withdraw your consent to participate at any time. Refusal to participate or withdraw carries no penalty or loss of benefits to which you are otherwise entitled. You can decline to answer specific questions or complete specific tasks at any time during the research. You may be withdrawn from the study if it is in your best interest or to protect the integrity of the study.

Cost and Compensation

There are no costs for you to participate in this study. You will not be paid for your participation in the study, or for the data collected, analysis of the data, information generated from the data of any product(s) or service(s) that result from your participation in this research of from the research project as a whole. Once the data is collected, it cannot be removed from the analysis.

If you have any questions or concerns about this study or if any problems arise, please contact the Principal Investigator, Terrie Hope at 1-888-820-2880.

Consent for participation in this research

I have read the information in this consent form. All my questions about the research and my participation in it have been answered. By signing this consent form, I have not given up any of my legal rights. I agree to participate in this research.

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