siology 63 (2007) 152–158www.elsevier.com/locate/ijpsycho

International Journal of Psychophy

The neuroimaging research process from the participants' perspective

Richard Cooke ⁎, Elizabeth Peel, Rachel L. Shaw, Carl Senior

School of Life and Health Sciences, Aston University, UK

Received 1 February 2006; received in revised form 1 March 2006; accepted 30 March 2006Available online 27 June 2006

Abstract

The aim of this study was to investigate participants' experiences of taking part in research conducted using fMRI or MEG procedures. Forty-four participants completed a questionnaire after taking part in either fMRI or MEG experiments; the questionnaire asked about experiences of andattitudes toward fMRI/MEG. Ten follow-up interviews were conducted to enable an in-depth analysis of these attitudes and experiences. Thefindings were generally positive: all participants thought fMRI and MEG were safe procedures, 93% would recommend participating inneuroimaging research to their friends and family, and participants were positive about participating in future neuroimaging research. However,some negative issues were identified. Some participants reported feeling nervous prior to scanning procedures, several participants reported side-effects after taking part, a number of participants were upset at being in a confined space and some participants did not feel confident about exitingthe scanner in an emergency. Several recommendations for researchers are made, including a virtual tour of the scanning equipment during theconsenting process in order to better prepare potential participants for the scanning experience and to minimize the potential psychologicaldiscomfort sometimes experienced in neuroimaging research.© 2006 Elsevier B.V. All rights reserved.

Keywords: fMRI; MEG; Side-effects; Consent; Screening; Perceptions; Interviews; Questionnaires

1. Introduction

Cognitive neuroscientific techniques, such as functionalmagnetic resonance imaging (fMRI), magnetoencephalography(MEG), and transcranial magnetic stimulation (TMS) havebecome dominant research tools within contemporary psycho-physiology. The advantages of such techniques are clear andreaders are referred to the various reports in this special issue fordetailed descriptions of their application (see Bandettini, 2006-this issue and Rippon et al., 2006-this issue, for descriptions offMRI and MEG procedures respectively). What is currentlyunknown is how healthy participants' expectations of andreactions towards these techniques impact on their experienceas experimental participants, and whether these experiencesinfluence future participation in neuroimaging research.

Research has been conducted to examine the experiences ofmedical patients who are referred for neuroimaging procedures.

⁎ Corresponding author.E-mail address: r.cooke@aston.ac.uk (R. Cooke).

0167-8760/$ - see front matter © 2006 Elsevier B.V. All rights reserved.doi:10.1016/j.ijpsycho.2006.03.014

For example, Grey et al. (2000) found that neurological andneuropsychiatric patients about to undergo MRI proceduresexhibited anxiety prior to these procedures, and that this anxietywas alleviated if patients were presented with an informationbooklet which described the MRI procedure and what theycould expect. Patients also appreciated being taken into thecontrol room, to see the scanning equipment, prior to their scan.In addition, Walter et al. (2001) reported that patients classifiedas depressed found TMS a positive procedure and wouldrecommend it to friends and family. Despite these findings, noresearch has been conducted to examine the experiences ofhealthy individuals who participate in neuroimaging proceduresfor experimental purposes.

The objective of this study, part of an ongoing researchventure (see also Cooke et al., 2005; Peel et al., 2005), is to gainsome insight into participants' psychological satisfaction withthe scanning procedures of two cognitive neuroscientiifictechniques, fMRI and MEG, in order to review current practiceregarding informed consent and screening. The level ofknowledge participants have of fMRI and MEG is unclear,making it impossible to know for certain whether sufficient

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guidance is given to enable an informed decision whenconsenting to an experiment. The ethical implications ofpotentially inadequate or inappropriate consenting or screeningprocedures are clear in both research and clinical contexts. It istherefore crucial to understand participants' attitudes towardand experiences of fMRI and MEG in order to ensure bestpractice in neuroimaging research.

Usually the first contact potential participants have withresearchers when responding to an invitation to participate in anexperiment involving fMRI or MEG is the screening process.Screening serves to make participants aware of safety issues andensures eligibility; in short, it aims to reduce risk. The consentprocedure will vary depending on the substance of theexperiment, its hypotheses and nature of stimuli, but genericinformation about the scanning procedure will be relevant to allstudies. There are differences between fMRI and MEGprocedures in terms of screening and procedures followed.Unlike MEG, there are certain restrictions imposed on who canparticipate in fMRI research. Participants are screened for anumber of conditions which preclude participation, includinghaving surgical clips or hearing aids, dental work, tattoos,epilepsy, heart disease and diabetes. Participants are alsoscreened for claustrophobia. These restrictions do not apply toMEG screening procedures. In addition, the scanning equip-ment means participants follow different procedures in fMRIand MEG. Participation in fMRI involves lying horizontally inthe centre of a magnetic bore, and participants have to wear earplugs because of the noise caused by the rapid switching of theradiofrequency coils. In contrast, MEG procedures involveparticipants sitting upright and there is no need to wear earplugsas MEG does not generate as much noise as fMRI.

However it remains uncertain whether these differences areapparent to participants, whether they impact upon theconsenting process, and, if there is an effect, what is its natureand significance for neuroimaging research. These questionswere addressed using a mixed method approach to establish thenature of participants' expectations of scanning, their experi-ences and their reflections of participating in fMRI and/or MEGresearch.

2. Method

2.1. Participants

Twenty-one (9 male, 12 female, 18–41 years, Mean=23.52,SD=7.17) participants completed a questionnaire specific tofMRI, while 23 (10male, 13 female, 18–60 years, Mean=24.83,SD=11.27) participants completed one specific to MEG, afterparticipation in either of the procedures (total N=44). Sevenparticipants had experience of fMRI prior to this study and fiveparticipants had experience ofMEG prior to the study. However,a majority of participants in both samples (14 fMRI, 18 MEG)had no experience of either technique prior to the study.

Ten (4male, 6 female, 18–47 years, Mean=29.67, SD=8.70)participants agreed to be interviewed following their scanningprocedures and completion of the questionnaire. All participantshad participated in fMRI research and eight had been through a

MEG procedure as well. Four of the participants wereundergraduate students, two participants were PhD students,one was a post-doctoral researcher, two were administrators andone was a specialist psychology technician.

2.2. Measures

Participants were given a questionnaire focusing either onfMRI or MEG (see http://www.aston.ac.uk/lhs/staff/A-Zindex/cooker.jsp for the fMRI questionnaire). Questionnaires wereidentical except for distinctions between scan techniques, forexample, the fMRI questionnaire is slightly longer becausethere was an extra question “How upsetting was the loud noiseof the scanner?” This is because the fMRI scanner generates aloud noise, whereas MEG is a passive recording device (seeabove). The questionnaires began with items on age and genderand then asked if participants had experienced the procedurebefore. Questionnaires were divided into three sections,experience of fMRI/MEG, knowledge about fMRI/MEG, andattitudes towards fMRI/MEG. All items in the questionnairesand subsequent interviews (see below) were carefully con-structed to concentrate on the generic aspects of the scanningprocess so that subsequent findings could be easily extrapolatedto inform best practice in other laboratories.

In this paper, we focus on the questions in the experience andattitudes section. Experience questions asked about expecta-tions prior to the scan, reactions after leaving the scanner(including any perceived side effects), experiences of the scan,and how confident participants' felt about exiting the scanner inan emergency. The attitudes section asked participants if theywould recommend fMRI/MEG to their friends and family, whothey would tell about their procedure, and about their plans toparticipate in future scanning research.

The interviews were semi-structured in that a series of topicsto be covered were identified in advance, but the process wasflexible enough to incorporate unexpected themes as they arose(Burman, 1994; Kvale, 1996). A set of open-ended questions,which acted as an aide mémoire, were devised to askparticipants about their reasons for consenting to the experi-ment, their expectations, the screening process, the experienceof being inside the scanner and their subsequent reactions tobeing scanned. A set of prompts were also included in theinterview schedule in case participants were not forthcomingabout their experiences.

2.3. Procedure

Data were collected from participants attending a number ofscanning experiments. After completing the experiment, par-ticipants were approached and asked to complete either the fMRIor the MEG questionnaire. At the end of the questionnaire was aninvitation to be interviewed for the second phase of this study.Participants were asked to include their contact details on a tear-off reply slip if they wished to be interviewed which was returnedseparately from the anonymous questionnaire. Participants weregiven two envelopes inwhich to return the questionnaire and replyslip to the investigators. Once participants had volunteered to be

154 R. Cooke et al. / International Journal of Psychophysiology 63 (2007) 152–158

interviewed they were taken through a separate consent processfor this follow-up interview. If consent was obtained a date andtime for the interview was arranged. Interviews were audio-recorded and transcribed verbatim.

2.4. Analytic approach

Due to the exploratory nature of this study descriptive dataonly are reported. Parametric tests of significance areinappropriate due to the small sample size. Interview datawere analysed using thematic analysis (Boyatzis, 1998), aqualitative method which involves a series of systematic stages.Interviews were transcribed orthographically; in the dataextracts presented dashes indicate cut-off speech, underliningdenotes emphasis and omitted speech is shown by an ellipsis,any additional information is contained in square brackets.Transcripts are read thoroughly in order that the analystfamiliarizes himself/herself with the data. These accounts arethen re-read in more detail to identify the themes raised byparticipants. Similarities and differences across the data set areinvestigated in order to establish the range of experiencesamong participants. Contradictions within individual partici-pants' accounts are also interrogated and hypotheses for whythese contradictions occur are formulated. The objective ofthematic analysis is twofold: to accurately portray participants'accounts; and to understand these accounts in terms of theirsignificance to the research question. In other words, theseinterviews were conducted to reveal, from the participants'perspective, the nature of the fMRI and MEG scanningprocedures starting with consent and screening through thescans themselves and ending with post-scan reflections.

3. Results

3.1. fMRI: questionnaire data

3.1.1. Emotional perceptions and side effectsWe asked participants to indicate if they were (or were not)

experiencing different emotions prior to entering the scanner.None of the participants said that they were “worried”,“agitated”, or “scared” prior to the scan. Nonetheless, therewas evidence that some participants were experiencingemotional arousal: even though 17 participants said they werenot anxious or nervous, nine said they were not “calm” whichsuggests that their experience fell between these extremes. Forthe majority of participants this was their first time in thescanner, so a degree of uncertainty about the process wasexpected among participants. However, participants did reportinterest in fMRI; 14 said they were “intrigued” prior to enteringthe scanner.

Seven participants reported perceived side-effects afterparticipating in an fMRI procedure. Three participants re-ported having a headache and one other said she/he had aheadache and ringing ears. It is possible these effects werecaused by the noise of the scanner. One participant reported amuscle ache, which may have occurred due to restrictioninside the scanner.

3.1.2. Experience of the procedureParticipants were asked if being in a confined space, in the

fMRI scanner, was upsetting. Nine participants reported thatbeing in a confined space was “a bit upsetting” but when askedto rate the whole experience of taking part in a fMRI scan, 18participants said it was not at all upsetting (one participant said“don't know”, one said “a bit upsetting” and one said“moderately upsetting”). The noise in the fMRI scanner wasdescribed as “not upsetting” by 12 participants, eight said it was“a bit upsetting” and one participant found it “moderatelyupsetting”. Participants were also asked how confident theywere that they could exit the scanner in the event of anemergency. Three participants were not at all confident of beingable to exit the scanner while 18 felt confident they could.Nonetheless, all participants believed fMRI was a safeprocedure to experience.

3.1.3. Communication about the procedureParticipants were asked who they would tell about their scan

in order to explore possible stigma associated with taking part inbrain scanning research. None of the participants intended tohide the fact that they had had a brain scan. When asked towhom they would recommend the procedure, 20 fMRIparticipants were happy to recommend the procedure to afriend or family member assuming researchers spoke to them inadvance and/or the study followed the correct procedures. Theother participant answered “don't know”. Finally, when askedabout future participation in fMRI research, participants werepositive about participation (Mean=3.90 on a 5-point scale)implying they would consent to similar experiments in thefuture.

3.1.4. fMRI: interview dataParticipants reported feeling at ease in the scanning

situation and were confident researchers knew what theywere doing. This corroborates the questionnaire finding thatparticipants believed the fMRI procedures were safe.Furthermore, some participants' reactions involved verypositive emotions: they described it as “quite enjoyable”(P3), “exciting” (P7) or “surprisingly relaxing” (P1). Indeed,most of the evaluations interviewees made about their fMRIexperience were positive. One of the advantages of semi-structured interviews is their capacity to reveal issues that areunexpected. Several themes did emerge from the interviewswhich were not addressed in the questionnaires; these relateto the visibility of the brain and the perceived relationshipbetween neuroimaging research and scanning for clinicalpurposes.

3.1.5. The visible brainOne of the aspects of the fMRI procedure that participants

particularly liked was the chance to ‘see’ their brain by lookingat the anatomical scan:

“it [fMRI] was quite enjoyable to take part in, especiallyafterwards being able to see like your own brain, it's quitegood to see” (P3)

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This view was echoed by other fMRI participants whoreported being “fascinated to see what it looks like” (P7) and“really looking forward to seeing my brain” (P8). It was not allpositive, however, there was some concern about medicalimplications if a problem was identified.

3.1.6. Risking the brainA generic procedure common to most MRI laboratories

around the world is informing the participants that their generalpractitioner (internist) will be notified directly should ananomaly be identified. The implications that the scan couldidentify medical concerns but that these would not be divulgedwere considered carefully by participants:

“you have to think of the ethical… repercussions of whatwould happen if you gave somebody a picture of their brainand then they later found out, because you had contactedtheir GP [general practitioner] that there was actually aproblem with them, take for instance a tumour or some-thing… If that was me who'd been led down the garden path‘oh this is a picture of your brain doesn't it look great' onlyto find three weeks later that I've got a letter from my GPsaying… ‘we think you've got a problem’… I certainlywouldn't like it to happen to me” (P10)

“What if they find something that they have to disclose toyou, no that didn't really enter my head, because I – well itdid sort of enter my head” (P7)

“I mentioned it to sort of friends and family, you know gohome ‘ooh I had my head scanned today’ [laughs] myhusband was a bit worried he said ‘what did you have thatdone for?’ he thought there was something wrong [laughs]”(P9).

These extracts reveal that participants consider theirscanning experience within the wider context of medicine andhealth and not just simply as taking part in research.

3.1.7. Experimental research as benign investigationThe previous quote reveals the anxiety felt by P9's husband

when she told him she had undergone a brain scan. Otherparticipants also highlighted the fact that they were taking partin a scan for experimental research rather than as part of amedical procedure:

“in terms of doing an experiment there's no stigma attachedto that. It's not like it's not like you would say ‘I've had anMRI scan’ and people would go ‘Oh you must have adisease or something’” (P1)

“the thing is it's much more reassuring when you're nothaving it done for medical reasons” (P7)

These quotes illustrate the common misconception that fMRIscans are only necessary to confirm the presence of a braintumour, as indicated by P10 above. In its medical context,having an fMRI scan has the associated stigma of being

connected to revealing brain pathology. However, whenconducted for research the scan is considered to be a benignprocedure.

3.2. MEG: questionnaire data

3.2.1. Emotional perceptions and side effectsPrior to entering the MEG scanner only one participant

described their emotional state as either “worried” or “sad”,although three participants did describe themselves as “anx-ious”. Eight participants reported being “scared” prior toentering the MEG scanner, 15 described not feeling scaredand six said they were “nervous”. Fifteen participants describedthemselves as “calm” before entering the scanner and eight saidthey were not. The majority of participants were taking part inMEG research for the first time and 13 described themselves as“intrigued” prior to the scan.

Eight participants reported some kind of side-effect afterparticipating in a MEG procedure, with some reporting morethan one. Overall, four participants reported headaches, sixreported muscle aches, and one ringing in the ears. Thefrequency of headaches and muscle aches being interpreted asside-effects of the scanning procedure suggests that furtherresearch is needed to explore this potential link.

3.2.2. Experience of the procedureParticipants were asked if the restricted movement in the

MEG scanner was upsetting. Thirteen participants said it was “abit upsetting” being in a confined space. Ratings of the wholeexperience of taking part in a MEG scan showed that 15participants found it “not at all upsetting” and eight said it was“a bit upsetting”. On being asked how confident they were thatthey could exit the scanner in an emergency, 16 participants feltconfident that they could, four participants were not confidentand three were unsure. Despite this, all participants believedMEG was a safe procedure.

3.2.3. Communication about the procedureWhen asked who they would tell about their participation

in MEG research nobody said they would hide their MEGexperience from others. Eight participants said they wouldrecommend participation in MEG research to friends orfamily assuming correct procedures were followed and 13would recommend it as long as participants talked toresearchers. One participant's response was “don't know”and one said she/he would not recommend it under anycircumstances. Nevertheless, participants were positive aboutparticipating in MEG research in the future (Mean=3.87 on a5-point scale).

3.3. MEG: interview data

MEGwas talked about less often than fMRI in the interviewsbut when it was, the general reaction was unfavourable, eventhe description of “nothing unpleasant” implies negativity:

“there was nothing unpleasant about it” (P1)

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“MEG was in a dark room I didn't like that… because it wasdark with this computer screen your eyes start going funny,because you were concentrating on just one tiny bit of lightand it was, it just wasn't as nice [as fMRI]. It was hard toconcentrate and just a bit more claustrophobic” (P3)

“physically it was a bit of a squeeze in the chair andeverything that they put on your head” (P4)

If participants had received both MEG and fMRI, theyreported being less impressed by their experience of MEG. Infact, the main theme in participants' accounts of MEG revealeda relational appraisal process, MEG was constantly comparedwith fMRI and was often classified as experientially the poorerof the two techniques.

3.4. fMRI versus MEG

Several participants explicitly compared the techniques:

“Out of the two, to be honest I prefer the MRI scanner”(P10)

“it [fMRI] was nicer, it was more comfortable… I felt a lotmore comfortable and a lot less claustrophobic than I did inthe MEG scan” (P3)

“the MEG is a little bit more invasive than the MRI, the factthat when you go in the MEG you have to take an imprint ofyour teeth” (P10)

These quotes show that MEG procedures were oftencompared unfavourably with fMRI. However, this preferencewas not conveyed across the board, some participants discussedtheir experience within the MEG scanner as “less constrained”and as having “more freedom” than fMRI despite having thehead physically restrained.

“[MEG] felt very different, first of all you're not cooped upin a tube erm so you just feel a little bit more freedom,obviously your head's clamped…it's like a big hairdryer ontop of your head, and erm you just have things taped to yourhead and you’ve got to stay really still, that was probablythe most difficult part.” (P5)

“in a way you probably feel a bit less-less less constrained[in the MEG scanner] erm well cause if-if I did actuallywant to get out of the scanner I probably could just put myhead down and physically get out whereas-whereas if I'mactually in the MRI obviously it's enclosed so if I do wannaget out I have to press the buzzer first then wait for someoneto come in and-and wheel me out.” (P6)

These extracts reveal different experiences of fMRI andMEG across participants. Some participants expressed concernabout being “enclosed” inside the fMRI scanner but othersdiscussed finding that the way the MEG scanner “clamped” thehead was “more claustrophobic”.

4. Discussion

This study aimed to explore participants' attitudes toward andexperiences of taking part in neuroimaging research. Partici-pants' expectations prior to being scanned, their beliefs aboutwhat the process involved, their assessment of the screeningprocess and their reflections following the scan were investi-gated. The objective was twofold: to determine whether currentprocedures for screening, consenting and scanning are adequate;and to establish the nature of participants' experiences ofscanning in order to identify whether any changes in the processare necessary to ensure best practice in neuroimaging research.

Evidence that participants were satisfied with the neuroima-ging procedures was identified: all participants described fMRIand MEG as safe and only three out of 44 participants would notunequivocally recommend them to friends and family —ensuring they talked to researchers and that correct procedureswere followed. This confirms that current procedures aresatisfactory. Nevertheless, a number of concerns were raised:first, several participants experienced negative emotions prior totheir scan; second, several participants reported side-effectsafter participating in neuroimaging procedures; third, physicalelements of the scan equipment, such as being in a confinedspace and the loud noise of the fMRI scanner, led participants toreport dissatisfaction; and finally, the equipment was not alwaysviewed as easy to exit in an emergency. The interview datarevealed other issues: participants were fascinated by fMRIprocedures and were very keen to get a look at their brain; theywere less impressed by the MEG scanner talking mainly aboutfMRI during the interviews; and finally, the potential medicalimplications of having a brain scan affected participants'perceptions of risk and anxiety prior to participation. Despite ageneral consensus that procedures are sound and participantshappy, in response to the concerns outlined above, severalrecommendations are proposed to enhance the research processfor participants.

4.1. Emotional perceptions

Participating in neuroimaging research was not an emotion-ally neutral process. Both fMRI and MEG participantsdescribed themselves as “not calm” or “nervous” prior to thescan. Furthermore, over a third of MEG participants admittedbeing “scared” prior to their scan. These results support the dataof Grey et al. (2000), which found that MRI proceduresproduced anxiety among medical patients. Fear of the unknownis an expected cause of anxiety prior to a novel experience. It ispossible this effect was magnified however due to the highlytechnical nature of the equipment, their complex scientificmechanisms and function as tools to reveal the nature of one'sbrain, which to the layperson (and psychophysiologist) ispossibly the most intriguing and mysterious of human organs.These negative emotions may be counteracted by providingmore detailed information which enables potential participantsto gain a clearer understanding of what the procedure wouldentail (see Grey et al., 2000, for an example). During theinterviews, participants suggested that seeing a video of the

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scanning procedure would reduce anxiety, as would witnessinganother person being scanned prior to their own scan.Alternatively, researchers could utilize a virtual tour of thescanner during the consenting process using computer-gener-ated animation of what happens (see Rosenberg et al., 1997, foran example of a simulator). Either of these suggestions could beeasily incorporated into the scanning procedure and they wouldserve as a comprehensive guide to the scanning experience. Thiswould reduce anxiety associated with these novel techniques.

4.2. Potential side-effects

The scientific literature has not identified any side-effects toreceiving an fMRI or MEG scan. Nevertheless, the ex silentioconclusion that side effects do not occur during theseprocedures is not supported by the current study. Thequestionnaire data revealed that participants did experienceside-effects. This does not mean these experiences were actuallycaused by the scanning procedure, to demonstrate that wouldinvolve manipulating the conditions under which individualsparticipate in scanning procedures; e.g., varying the length oftime participants are in the scanner to see if shorter scans areassociated with fewer side-effects. What it means is participantsexperienced discomfort during or following participation in theexperiment. It is the responsibility of experimenters to minimizethe occurrence of this discomfort. Seven participants reported aheadache after either fMRI or MEG and six MEG participantsmentioned muscle ache following that procedure. The muscleaches may have been caused by a combination of anxiety andsitting still for long periods of time. The fact that such acheswere not described following fMRI scans indicates thatparticipants were able to relax more easily in the horizontalposition needed for fMRI than in the sitting position required forMEG. It may therefore be beneficial for researchers to conductMEG scans with the participants in a supine position. Furthersuggestions to overcome this problem include the introductionof more breaks in studies during which participants areencouraged to move around; this could be accompanied bysome relaxation techniques prior scanning to ensure the musclesare relaxed (Lukins et al., 1997; Quirk et al., 1989; Weinmanand Johnston, 1988).

Accounting for the headaches is more challenging. The verynature of both fMRI and MEG render straightforward solutionsto headaches difficult to implement. Being required to remainstill in the MEG may cause tension headaches in a similar wayto the muscle tension described above.

4.3. Being in a confined space

Being in a confined space was reported as “a bit upsetting”by 43% of fMRI and 57% of MEG participants which suggeststhat the situation itself (i.e., being inside a scanner) is stressfulfor some participants. The virtual tour described above mayserve to reduce this problem. Providing an accurate represen-tation of the physical confines of scanners (in some form), priorto participants consenting to take part in neuroimaging research,is important. If potential participants have a clearer idea of how

restricted they will be inside the scanner they will be able tomake an informed decision about whether they would feelcomfortable (or not) entering the scanner.

4.4. Exiting the scanner

One of the most concerning findings was that three fMRI andfour MEG participants did not feel confident that they could exitthe scanner in an emergency, a further three MEG participantswere unsure. Generic scanning procedures include explicitguidance on what to do should there be an emergency but thisfinding from our study suggests this may be inadequate. Theseconcerns contrast with participants' reports of feeling safe andraise questions about the level of information given toparticipants in advance of the scan. This limitation couldagain be addressed by the virtual tour; a demonstration of all thenecessary steps to initially alert the experimenter and then toactually exit the scanner may alleviate this lack of confidence.

4.5. Function of the scan

Probably the most intriguing aspect of participating in anfMRI experiment, as reported in the interviews, was being ableto see a picture of one's own brain. Also apparent was thatparticipating in research prompted less anxiety than wasexpected prior to a clinical fMRI scan to investigate a medicalcondition. It is possible then that the anxiety, and side-effects,reported in this study are minor, relative to the perceptions ofpatients attending for a medical scan. In one sense, this study actsas a control where emotional and physical reactions to the scanequipment and experience can be investigated without thepotential confound of ill health. This finding suggests the needfor a similar study with clinical patients to review the consentingprocess when applied to a medical scan in order to reduceanxiety and ensure best practice. The research by Grey et al.(2000) suggests that some patients are anxious about attendingMRI procedures but Grey et al. acknowledge that it is unclearwhich elements of the procedure reduce or increase anxiety.Thus, more in-depth data collection, potentially using inter-views, is needed to explore anxiety among clinical populations.

A related concern is the procedure for referring participantsto appropriate health services if a potential condition isidentified during the research process. Several participantsacknowledged the potential identification of a medical problemas a risk when consenting to participate in neuroimagingresearch. Potential participants need to be made aware that thereis a slight chance that brain scanning could identify a problemcurrently unknown to them. Subsequently, they need to knowthe precise procedures for referral before consenting to theexperiment. This could be easily dealt with by providing clearinformation about what would happen in the unlikely event thata medical condition was discovered.

4.6. Implications and future directions

This study has highlighted several implications for neuroi-maging research practice, outlined above, which may further

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prepare potential participants for the scanning experience andtherefore reduce anxiety. One avenue for future research is toimplement a validated measure of anxiety such as the State-TraitAnxiety Inventory (STAI: Spielberger, 1983) which wouldprovide baseline anxiety levels and therefore rule out thepossibility that participants reporting anxiety are not justgenerally more anxious than participants not reporting anxiety.

An in-depth debrief of all neuroimaging participants, whichaddresses both physical and psychological comfort, should beconsidered a generic part of best practice in neuroimagingresearch. This may be particularly important with participantswho come for their first scan; if they are anxious or haveperceived side-effects after the scan, and have not had theopportunity to discuss these concerns, they may havemisconceptions about scanning procedures and be unlikely toparticipate in future research.

A more detailed inquiry into the reasons for the negativeemotions felt by participants, including anxiety, fear andnervousness, is required to enable researchers to designscreening and consenting procedures which minimize thesefeelings. Further research is already underway which involvesinterviewing participants before and after the scan to ascertainthe nature of their expectations and experiences of the scanningprocedure from beginning to end. This is something whichcould then be transferred to a clinical setting with a view todesigning interventions which better prepare patients for theirbrain scan. The recommendations above will be combined withfuture research findings to inform evidence-based guidelines forneuroimaging research practice.

In conclusion, this study has confirmed that currentprocedures for fMRI and MEG scanning experiments areappropriate and that participants feel safe when inside thescanner. However, a number of improvements to procedureshave been indicated to further reduce anxiety and discomfort.These results highlight the utility of asking participants abouttheir experience of neuroimaging procedures as a way toidentify concerns of which researchers are not aware. Futureresearch is needed to build on these findings in order to bothsustain the rigour of neuroimaging procedures and to ensureparticipants' welfare.

Acknowledgements

This research was funded by The British Academy (#SG-39562). The authors thank the experimenters who assisted in

recruitment for this project, the questionnaire respondents andinterviewees, and Hannah Smyth for conducting and transcrib-ing the interviews. The comments of an anonymous reviewerare also gratefully acknowledged.

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