TMS & Brain Function

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Thank you for your interest in these healthy volunteer research studies that investigate ways to improve noninvasive brain stimulation (NIBS)! Research participants help NIH advance science and transform the understanding and treatment of mental illnesses, paving the way for prevention, recovery, and cure.

Please answer these brief questions to begin the screening process. Submitting answers does not obligate you to participate. You may decide you are no longer interested at any time.

Learn more about protocol #18-M-0015 studies here:

Umbrella Study: https://www.nimh.nih.gov/research/research-conducted-at-nimh/join-a-study/adults/tms-and-brain-function

Sub-study #3: https://www.nimh.nih.gov/research/research-conducted-at-nimh/join-a-study/tms-and-brain-function-sub-study-3-controlling-your-own-brain-activity-with-neurofeedback

Please note that, once enrollment has closed, we will remove your identifiers from our data base.

First and Last Name

* must provide value

Survey Status:

* must provide value

Unverified

Verified

1st Contact Date

M-D-Y

2nd Contact Date

M-D-Y

Screening Call Date (for postcard table)

M-D-Y

Screening Status

First Pass Screening

Clinician Screening

Ruled Out at First Pass Screening

Ruled Out at Clinician Screening

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Reason for Rule-Out?

Unreachable

Diagnosis

Not Interested

Neurological Condition

Time Commitment

Medication History

Physical Health

Episode Issue

TMS History

ESL

Age

Travel

Did Not Specify

SUD

Cannot End Current Treatment

Seizure History

TBI

Recreational Drug Use

Claustrophobic

ETPB Number

Date of Birth

* must provide value

M-D-Y

Age

View equation

E-Mail

* must provide value

Phone Number

* must provide value

What are the best days/times to contact you?

* must provide value

Have you ever been diagnosed with a psychiatric or psychological disorder?

Yes

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Please select any psychiatric or psychological diagnoses you have received.

Major depressive disorders

Bipolar disorder

Post-traumatic stress disorder

Generalized Anxiety Disorder

Obsessive Compulsive Disorder

Attention-deficit/hyperactivity disorder

Other

Do you have any serious health problems?

Yes

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Are you taking any medications for your physical health?

Yes

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What medications are you on for your physical health?

Please describe any other psychiatric or psychological diagnoses you have received.

Are you willing to look at aversive images?

Yes

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Are you right-handed, left-handed, or ambidextrous?

right

left

ambidextrous

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Do you or any of your family members (parents, siblings) have a history of seizure or epilepsy?

Yes

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Have you ever had a head injury where you lost consciousness for more than 5 minutes?

Yes

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Are you willing and able to come to the NIH, Bethesda, MD on a weekday several times for between 2-4 hours each time?

Yes

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Do you have any metal (i.e. titanium, stainless steel) implants in your body?

Yes

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Please describe the type of implants you have (material, location).

Do you have any permanent metal retainers?

Yes

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Have you ever had TMS before?

Yes

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How did you find about this study?

Would you be willing to be contacted for other studies?

Yes

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Do you consent to this information being stored on our screening database?

* must provide value

Yes

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Question	Response	Requirements	Rule Out if...
Age	______	18-35	Over 35
Fluent in English	[first_language_hv]	Yes	No
Psychiatric Diagnosis	______	No	Yes
Psych Diagnoses Received	______, ______	None	Anything: MDD, bipolar, etc.
Currently Depressed	[depression_current]	No	Yes
Seizure History	[seizure], [family_seizure]	No, No	At least 1 Yes
Head Injury	______	No	Yes
Commitment	______	Yes	No
Metal	______, ______	No	At least 1 Yes --> Ask for documentation
Aversive Images	______	Yes	No
Psych Meds	[adhd_med_hv]	No	Yes
Health Problems	______	No	Yes --> Consult clinician about severity
Health Meds	______	No	Yes --> Consult clinician about whether meds lower seizure threshold

Non-Native English Speaker: [first_language_hv]
Psychiatric Diagnosis: ______
Psych Diagnoses Received: ______, ______
Currently Depressed: [depression_current_hv]
Seizure History: [seizure_hv], ______
Head Injury: ______
Commitment: ______
Metal: ______, ______

Aversive Images: ______

Psych Meds: [adhd_med_hv]

Health Problems: ______

Health Meds: ______

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