Brain Stimulation Study of Human Visually-guided Navigation Using Repetitive Transcranial Magnetic Stimulation (rTMS)
Phase: NA
Conditions: Healthy Participants
Sponsor: Emory University

Study Protocol 
 
TITLE: Brain stimulation study of human visually-guided navigation 
using repetitive transcranial magnetic stimulation (rTMS) 
 
NCT NUMBER: NCT04961645 
 
Protocol Date: April 11, 2021 

Protocol Title: Brain stimulation study of human visually-guided navigation using repetitive 
transcranial magnetic stimulation (rTMS)
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PROTOCOL TITLE: Brain stimulation study of human visually-guided navigation using repetitive 
transcranial magnetic stimulation (rTMS)
EXTERNAL (NON-EMORY) COLLABORATORS                                                                   
None
PRINCIPAL INVESTIGATOR: 
Name: Daniel D. Dilks, Ph.D 
Department: Department of Psychology 
Telephone Number: 
Email Address: 
VERSION: 1.00 – 04/11/21
FUNDING SOURCE: NIH 5-R01-EY029724 - 03, Department

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transcranial magnetic stimulation (rTMS)
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REVISION HISTORY
Revision #
Version 
Date
Summary of Changes

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transcranial magnetic stimulation (rTMS)
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Table of Contents
1.
Study Summary .......................................................................................................................5
2.
Objectives................................................................................................................................5
3.
Background .............................................................................................................................5
4.
Study Endpoints ......................................................................................................................5
5.
Study Intervention/Investigational Agent...............................................................................6
6.
Procedures Involved................................................................................................................6
7.
Data Specimen Banking...........................................................................................................7
8.
Sharing of Results with Participants........................................................................................7
9.
Study Timelines .......................................................................................................................8
10.
Inclusion and Exclusion Criteria...........................................................................................8
11.
Vulnerable Populations .......................................................................................................8
12.
Local Number of Participants ..............................................................................................9
13.
Recruitment Methods..........................................................................................................9
14.
Withdrawal of Participants................................................................................................10
15.
Risk to Participants ............................................................................................................10
16.
Potential Benefits to Participants......................................................................................10
17.
Compensation to Participants ...........................................................................................10
18.
Data Management and Confidentiality .............................................................................10
19.
Provisions to Monitor the Data to Ensure the Safety of Participants................................11
20.
Provisions to Protect the Privacy Interest of Participants .................................................12
21.
Economic Burden to Participants ......................................................................................12
22.
Informed Consent..............................................................................................................13
23.
Setting................................................................................................................................15
24.
Resources Available...........................................................................................................16
25.
Multi-Site Research When Emory is the Lead Site.............................................................16
26.
References.........................................................................................................................17

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1. Study Summary
Project Title
Brain stimulation and visually-guided navigation 
Project Design
In this project, participants will volunteer, based on 
recruitment efforts such as the Psychology student 
database. There is no random assignment. The number 
of subjects for each experiment was determined using a 
power analysis. The intervention is transcranial 
magnetic stimulation (TMS). 
Primary Objective
Testing the causal role of OPA using repetitive TMS 
(rTMS)
Secondary Objective(s)
None
Research 
Intervention(s)/Interactions
TMS
Study Population
Typical adults (18 years or above)
Sample Size
38 
Study Duration for 
individual participants
2 visits – 90 minutes each
Study Specific 
Abbreviations/ Definitions 
rTMS – repetitive transcranial magnetic stimulation
OPA – Occipital Place Area
fMRI – functional magnetic resosnance imaging
Funding Source (if any)
NIH 5-R01-EY029724 - 03
2. Objectives
In this study, we are investigating the neural mechanisms causally involved in how people 
navigate through their immediately visible environment (e.g., walking around one’s bedroom 
flawlessly and effortlessly, not bumping into the walls or furniture). To investigate whether 
particular neural mechanisms are causally involved in “visually-guided navigation”, we use 
repetitive transcranial magnetic stimulation (rTMS) to temporarily disrupt the functioning of 
particular brain regions in healthy adults while we show them simple visual stimuli of places 
(e.g., bedrooms, kitchens, and living rooms) and ask them to perform simple computer tasks 
(e.g., imagine they are walking through the room, and respond via button press whether they can 
leave through a door on the left, center, or right wall, as indicated by a continuous path on the 
floor), or ask them to complete simple behavioral tasks (e.g., actually walk around a small room 
and search for hidden objects).

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3. Background
Our ability to navigate through our immediately visible environment is crucial for our survival. 
However, the representations and computations underlying this remarkable ability are not well 
understood, and current computer vision algorithms (robots) still lag far behind human 
performance. One promising strategy for attempting to understand “visually-guided navigation” 
is to characterize the neural systems that accomplish it. Indeed, the results – albeit only from a 
handful of studies over the past five years – from functional magnetic resonance (fMRI) on adult 
humans have begun to elucidate the cortical regions involved in visually-guided navigation, with 
the central finding that there is at least one visual cortical region – called the occipital place area 
(OPA) (Dilks et al., 2013) – that may play a central role in our ability to navigate through 
currently visible places (e.g., walking around our bedroom flawlessly and effortlessly, not 
bumping into the walls or furniture our bedroom) (Persichetti & Dilks, 2018; Kamps et al., 2016; 
Kamps et al., 2018).  However, given that fMRI is a correlational method, and we need to know 
if this functionally specific brain region is causally involved in visually-guided navigation. 
Understanding the causal involvement of this region will provide important clues about how 
humans navigate their world, and also perhaps someday be harnessed to help those individuals 
who devastatingly lose the ability to navigate, as a result of eye diseases, brain surgery, stroke, 
neurodegenerative diseases, or developmental disorders.   
      
The use of rTMS to investigate the causal involvement of particular brain regions in particular 
human abilities (as proposed here for the causal involvement of OPA in visually-guided 
navigation, in particular) is not novel. Several studies (Pitcher et al, 2007; Pitcher et al., 2008; 
Pitcher et al., 2009; Sadeh et al., 2011; Pitcher et al., 2012; Solomon et al., 2013; Pitcher, 2014; 
Pitcher et al., 2014) have used it to investigate face recognition, two studies (Dilks et al., 2013; 
Ganaden et al., 2013) have used it to investigate scene recognition (i.e., our ability to recognize, 
not navigate through, a bedroom, for example), and yet two other studies (Rafique et al., 2015; 
Mullin et al., 2013) have used it to investigate object recognition. In all of these studies, the 
disruption of face, scene, or object recognition occurred between ~50 to 150 ms after a briefly 
flashed stimulus, and after that all processing returned to normal. This brief temporal window of 
disruption demonstrates that the effects of rTMS on visual cortex are very transient (see 
Bolognini & Ro, 2010 and Wassermann, 1998 for reviews), and no permanent disruption of 
function has ever been reported. After the experiment, participants will remain under supervision 
for about 15 minutes, verbally confirm they feel safe to leave (after the 15 minutes), and then 
will be escorted to the exit.  
4. Study Endpoints 
The general question for this research is to determine, using rTMS, the causal involvement of OPA in 
visually-guided navigation, using two tasks (a simple computer-based task and a simple behavioral task, 

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described above in the Abstract, and again just below). Given this question then, we propose to test the 
following two specific hypotheses:
Experiments involving the simple computer-based task (e.g., imagine you are walking through 
the room, and respond via button press whether they can leave through a door on the left, center, 
or right wall, as indicated by a continuous path on the floor)
i) If OPA is causally involved in visual scene navigation, then disruption of this region, using 
rTMS, will lead to a decrement in performance on the “visually-guided navigation task” (i.e., 
imagine you are walking through the room, and respond via button press whether they can leave 
through a door on the left, center, or right wall, as indicated by a continuous path on the floor), 
but not on the “scene categorization task” (i.e., imagine you are standing in the pictured room, 
and respond whether you are in a bedroom, kitchen, or living room) – the control condition.  
Primary outcome measure: To determine baseline performance, we will also apply rTMS to a control site 
(i.e., the vertex – a bit of the brain at the very top of the head, not implicated in visually-guided 
navigation, and identified as the direct midpoint between the bridge of the nose and the inion, and between 
the participants’ temples), and predict a decrement in performance on the visually-guided navigation task, 
only after rTMS is applied to OPA (but not vertex). There are no secondary outcome measures. 
Experiments involving the simple behavioral task (i.e., actually walk around a small room and 
search for hidden objects).
ii) If OPA is causally involved in visually-guided navigation, then disruption of this region, using rTMS, 
will lead to a decrement in performance in navigating through the room to find a hidden object, but not in 
identifying what the object is (the control condition). 
Primary outcome measure: As described just above, to determine baseline performance, we will also apply 
rTMS to the control vertex site, and predict a decrement in performance on the visually-guided navigation 
task, only after rTMS is applied to OPA (but not vertex). There are no secondary outcome measures. 
5. Study Intervention/Investigational Agent 
TMS, first successfully demonstrated in 1985 (Barker et al., 1985), is a very safe and 
noninvasive method for affecting brain function. It relies upon the properties of electromagnetic 
induction; a rapidly changing magnetic field is generated when a high-voltage current is passed 
through a coil. When this coil is held in close proximity to any electrically conducting medium 
(such as the brain), this time-varying magnetic field induces current in a direction opposite to the 
original current in the coil. As a result of this ion flow, action potentials are triggered in neurons 
that are within the induced current field, along with a subsequent period of deactivation, 
presumably through prolonged inhibitory postsynaptic potentials (i.e., making a postsynaptic 
neuron less likely to generate an action potential). Because normal ongoing brain activity is 
disrupted by this induced current, TMS provides a way for investigators to produce a transient 
and reversible period of brain disruption or “virtual lesion.” Thus, unlike other experimental 

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techniques [e.g., fMRI, electroencephalography (EEG)/ event-related potentials (ERPs)], TMS 
can assess whether a given brain area is necessary for a given function, rather than simply 
correlated with it. Again, TMS has been used in many studies investigating those brain areas 
(identified with fMRI) to be causally involved in face, scene, and object processing (Pitcher et al, 
2007; Pitcher et al., 2008; Pitcher et al., 2009; Sadeh et al., 2011; Pitcher et al., 2012; Solomon et 
al., 2013; Pitcher, 2014; Pitcher et al., 2014; Dilks et al., 2013; Ganaden et al., 2013; Rafique et 
al.., 2015; Mullin et al., 2013). 
The TMS device is housed in the Facility for Education & Research in Neuroscience (FERN), 
Psychology and Interdisciplinary Studies Building, #795, Emory University, 36 Eagle Row, 
Suite 180, Atlanta, Georgia 30322.
6. Procedures Involved
Participation will require up to two visits each taking about one and a half hours. During the first 
visit, participants will be scanned (using fMRI). Before scanning, all participants will be asked to 
remove all jewelry and other metal-containing objects (including credit cards). They will then 
enter a large room where a powerful magnet is located. They will be asked to lie down on a 
narrow table and will be put in a small tunnel approximately 6 feet long and 2 feet in diameter. 
They will then be asked to lie as still as possible during the scan for approximately 90 minutes. 
During scanning, they will hear a loud banging noise as the MRI machine takes pictures of their 
brain. As a consequence, they will be given earplugs to make them more comfortable. While 
they lie in the scanner, a computer display will be placed at one end of the tunnel. They will be 
able to see the display through the back-projecting mirror in front of their face. Once scanning 
begins, they will then need to respond to things they see on the display screen, and for this they 
will be given a small box with buttons that will be placed under their hand when they are placed 
into the scanner. Specifically, they will be asked to view pictures of faces, places, objects, and 
abstract patterns. Such “localizer” stimuli enable us to identify (or localize) the brain region (i.e., 
OPA) in each individual using fMRI that will then be targeted with rTMS in the proposed study.
During the second visit (the rTMS visit), participants will be seated comfortably in a chair and 
asked to complete either a simple computer-based task (e.g., imagine you are walking through 
the room, and respond via button press whether they can leave through a door on the left, center, 
or right wall, as indicated by a continuous path on the floor), or a simple behavioral task that will 
require them to actually walk around in a small room and search for hidden objects. Either 
during, or just before, each of these tasks, participants will receive rTMS. In rTMS, we place 
a small plastic coil next to the participant’s head. The position of the coil will be guided by the 
fMRI study described just above, which was conducted on that participant in the prior visit. The 
coil will be placed over the relevant brain region using the Brainsight TMS-MRI co-registration 
system for visualizing the coil position with respect to the participant’s individual fMRI scan. 
The coil will then generate a magnetic pulse, and stimulation will occur.  During stimulation, the 
participants may feel a gentle flick, and hear an audible click. The pulse is not usually painful, 
but it can cause a twitch of the hand or face muscles. Even though hearing loss is a rare 

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occurrence from rTMS, hearing protection (i.e., ear plugs) will be used during the TMS 
experiments. 
Instead of having source records (i.e. surveys), we are only going to collect brain image data for 
the fMRI portion of the study and psychophysical data for the rTMS portion. No further data is 
collected after procedures are completed.
During the experiment, participants may withdraw at anytime. After the experiment, participants 
will remain under supervision for about 15 minutes, verbally confirm they feel safe to leave 
(after the 15 minutes), and then will be escorted to the exit. If participants do not feel safe to 
leave after the 15 minutes is up, they will be asked to stay until you do feel safe to leave. If 
further assistance is needed, Dr. Gregory Berns (M.D./Ph.D), the head of FERN, will be 
contacted to come to the testing room.   
7. Data Specimen Banking
All participants will be given a non-identifying ID number. Hardcopy data will be kept in a 
locked filing cabinet in a secure office. Electronic data will be stored on a secure electronic hard 
drive. Electronic data will also be shared with Emory University and will be secured according to 
Emory IT policies. 
8. Sharing of Results with Participants
The research material obtained will consist only of brain images (MRI and fMRI), and 
psychophysical data (rTMS) that will be used solely for research purposes. We will not make use 
of any existing specimens or records. The data and subject identity will remain confidential. All 
participants will be identified by codes known only to the members of my research team. All 
paper data will be secured in a locked filing cabinet in a secure office in the Psychology Building 
at Emory University. All electronic data will be password protected and stored on a computer in 
the Psychology Building at Emory University, according to Emory IT policies. 
Furthermore, the study team will review the MRI scan. If there are any incidental findings or we 
discover that data from the scan suggest something that may be important clinically, we will 
share them with Dr. Gregory Berns, the head of FERN, who will determine its clinical relevance.
9. Study Timelines
Participation will require up to two visits. During the first visit, participants will be asked to lie 
as still as possible during the fMRI scan for approximately 90 minutes. During the second visit 
(the rTMS visit), participants will be seated comfortably in a chair and asked to complete either 
a simple computer-based task or a simple behavioral task that will require them to actually walk 

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around in a small room and search for hidden objects. This will also take approximately 90 
minutes.
Study enrollment will begin shortly after IRB approval and continue until all participants’ data 
are collected (38 adults). Based on our prior experience with collecting TMS data in typical 
adults, we estimate that we can successfully complete the two proposed studies within two to 
three years. 
10. Inclusion and Exclusion Criteria
Inclusion:  
i)  Healthy adults aged 18 and up 
ii) Normal or corrected-to-normal vision
Exclusion: 
i) no metal in the body
ii) personal or first-degree family history of epileptic seizure 
iii) a known brain injury 
iv) claustrophobia 
v) taking certain medications that may increase the risk of seizures (e.g., bupropion, varenicline, 
chlorpromazine, theophylline) or reduce the effects of rTMS, such as benzodiazapines
vi) Adults unable to consent, pregnant women, prisoners
11. Vulnerable Populations
This research does not involve any individuals who are in the vulnerable populations list.
12. Local Number of Participants
We plan to enroll about 38 healthy adult participants (19 for each of the two proposed 
experiments). The number of participants was determined using a power analysis, with an effect 
size of ηP2 = 0.14 (estimated from previous similar studies), an alpha level of 0.05, and power at 
two levels: 90% and 80%. Thus in each of the two proposed studies, we will test 19 participants 
(90% power), but could lose 4 participants to attrition and still have 80% power. Note in prior 
TMS studies, a similar number of participants were tested.  
We will recruit an equal number of men and women, and all efforts will be made to recruit 
minorities. No exclusion of women and minorities is necessary for this study. Census estimates 
from 2010 for Atlanta, Georgia, were 43.1% white, 50.1% African American, 0.2% American 

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Indian and Alaskan Native, 2.7% Asian, and <1% Native Hawaiian and other Pacific Islander; 
Hispanic or Latino were 5.3%. Using these census estimates, we will recruit minority 
participants to ensure that the subject sample represents the community. Recruitment of women 
and minorities will be assessed quarterly to ensure adequate representation. Participants will be 
recruited via the subject pool database maintained by the Emory University Psychology 
Department. 
13. Recruitment Methods
Participants will be recruited via the subject pool database maintained by the Emory University 
Psychology Department. The database involves names and contact information of people who 
have agreed to participate in research for course credit (1 credit up to 60 minutes) or to be paid 
for their participation. However, the participants in this study will not receive credit, but rather 
will be paid $20/hour in cash for the rTMS portion. For the fMRI portion, the participants will be 
paid $25/hour. Additionally, participants may be recruited in the community and at Emory 
University by word of mouth. No flyers or printed advertisements will be used.
To ensure that the participant does not have any metal in his or her body, the study team 
administers a screening form (attached) to the participant both during recruitment and before 
going into the scanner. Furthermore, to minimize any possible risk of a seizure during testing, the 
participant will certify that neither she, nor parents, brothers or sisters, or children have ever 
suffered an epileptic seizure. The participant will also certify that she has never suffered a known 
brain injury, and that she is not taking certain medications that may increase the risk of seizures 
or reduce the effects of rTMS. To ensure that the participant does not have any of the above 
contraindications, the study team administers another screening form (attached) to the participant 
both during recruitment and before study participation.
14. Withdrawal of Participants
Some people become nervous or claustrophobic (anxious or afraid of closed spaces) in the fMRI 
scanner. If this happens to the participant, they may ask to be withdrawn immediately. They may 
also experience a sense of dizziness in the magnet. Such dizziness is due to the strong magnetic 
field, and if it disturbs them, they may ask to be withdrawn.
The most common risk and discomfort of rTMS expected in this study is mild discomfort or 
tingling due to twitching of muscles in the head or face. If, at any time, the participant feels 
uncomfortable due to such twitching, he or she may indicate so verbally, and we will stop the 
experiment. In the studies cited above between 5-15% of participants experience discomfort, and 
withdraw from the study.
The study team has the right to end the subject’s participation in this study for any of the 
following reasons: If it would be dangerous for the participant to continue, if the participant does 

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not follow study procedures as directed by the study team, or if the sponsor decides to end the 
study.
The subject’s participation is voluntary, and she has the right to refuse to be in this study. The 
participant can stop at anytime after giving her consent. The participant has the right to leave a 
study at any time without penalty. The participant may refuse to do any procedures the she does 
not feel comfortable with, or answer any questions that she does not wish to answer. If the 
participant choose to withdraw, she can request that her information not be used in the study.
15. Risk to Participants
With fMRI, the risks are minimal. For example, the MRI machine is loud (similar to riding in a 
loud train), and, as such, participants will be given earplugs to lessen the noise. Participants may 
experience some muscle discomfort while lying in the scanner. They may also become too hot or 
too cold, in which case they may ask for an adjustment of room temperature or a blanket. Some 
people become nervous or claustrophobic (anxious or afraid of closed spaces) in the scanner. If 
this happens to the participant, they may ask to be withdrawn immediately. They may also 
experience a sense of dizziness in the magnet. Such dizziness is due to the strong magnetic field, 
and if it disturbs them, they may ask to be withdrawn. Because the magnetic field will affect any 
metallic object, they should not participate if they have any type of metallic implant in their 
body, including pacemakers, aneurysm clips, shrapnel, metal fragments, orthopedic pins, screws, 
or plates, metallic IUD’s, or piercings that you cannot remove. If potential participants have any 
of these items in their body, there is a risk that the magnetic field could cause them to move or 
heat up. It is important that they inform the study personnel if they have any implants. To ensure 
that the participant does not have any metal in his or her body, the study team administers a 
screening form (attached) to the participant both during recruitment and before going into the 
scanner. 
This type of brain scan is not designed to detect problems of the brain. A radiologist will not be 
reading the scan. The study team will review the scan. If there are any incidental findings or we 
discover that data from the scan suggest something that may be important clinically, we will 
share them with Dr. Gregory Berns (M.D./Ph.D), who will determine its clinical relevance, and 
contact you with further information (e.g., to seek a health professional).
With rTMS, there are minimal risks involved with this procedure (Wasserman, 1998), although it 
may at times be unpleasant. The most common risk and discomfort of rTMS expected in this 
study is mild discomfort or tingling due to twitching of muscles in the head or face. If, at any 
time, the participant feels uncomfortable due to such twitching, he or she may indicate so 
verbally, and we will stop the experiment. In the studies cited above between 5-15% of 
participants experience discomfort, and withdraw from the study. The twitching immediately 
subsides after the TMS is no longer administered. Some people undergoing TMS (approximately 
3%) also experience headaches, which are believed to be due to excessive muscle tension. In the 
case of a headache, the experiment will be immediately stopped. The headaches are not recurring 

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and subside following termination of the procedures. Also, approximately 1% of people 
undergoing TMS experience neck stiffness and neck pain. This stiffness and pain are believed to 
be due to the straight posture of the head and neck during the application of TMS. In the case of 
neck stiffness and/or pain, the experiment will be stopped. There are no reports of any such 
effects recurring. 
Next, TMS produces a clicking noise when the current passes through the coil. This click can 
result in tinnitus and transient decreased hearing if no protection is used. To prevent this adverse 
effect all experimental participants will wear earplugs. Animal and human studies have 
demonstrated that earplugs can effectively prevent the risk of hearing disturbances or discomfort 
due to TMS. The ear protection devices reduce the intensity level of the click to approximately 
80 dB. 
Finally, risk of seizures in healthy participants is very low, but not zero. Loo et al. (2008) 
provide a particularly useful and comprehensive review of all reported seizures in healthy 
participants that have occurred during TMS. In the first one, a participant experienced a seizure 
during TMS (Tharayil et al., 2005). This participant was taking chlorpromazine, and had some 
family history of epilepsy (a brother experienced a childhood seizure). In the second incident, an 
event resembling a seizure was reported during TMS stimulation (Nowak et al, 2006). However, 
that case is disputed and may instead have been an incidence of fainting, not a seizure (Epstein, 
2007). In any case, no long-term effects were found in follow-up neurological exams or EEG. 
Given that these are the only two cases of seizures or possible seizures that have been reported 
from the thousands of participants (probably tens of thousands of participants by now) who have 
experienced TMS, the risk of such events from the stimulation in the proposed study would seem 
to be very small. That said, to minimize any possible risk of a seizure during testing, the 
participant will certify that neither she, nor parents, brothers or sisters, or children have ever 
suffered an epileptic seizure. The participant will also certify that she has never suffered a known 
brain injury, and that she is not taking certain medications that may increase the risk of seizures 
or reduce the effects of rTMS. To ensure that the participant does not have any of the above 
contraindications, the study team administers a screening form (attached) to the participant both 
during recruitment and before study participation. If, in the rare event, the participants 
experience a seizure, Dr. Gregory Berns (M.D./Ph.D.) will be contacted immediately to come to 
the testing room, and Emory EMS ( 404-727-6111) will also be contacted immediately.   
For the computer-based and behavioral tasks, the risks are minimal. The participant may become 
frustrated or tired. We will provide encouragement and rest-breaks as needed. During both tasks, 
a study assistant will be in the room with the participant the entire time. 
16. Potential Benefits to Participants
There is no direct benefit to individual participants from taking part in this study. 

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17. Compensation to Participants
During the first visit (fMRI), participants will receive $25/hour to compensate for their time and 
effort. During the second visit (rTMS), the participants will receive $20/hour to compensate for 
their time and effort. If they do not finish the study, we will compensate them for the time they 
have completed. 
18. Data Management and Confidentiality
All participants will be given a non-identifying ID number. Hardcopy data will be kept in a 
locked filing cabinet in a secure office. Electronic data will be stored on a secure electronic hard 
drive. Electronic data will also be shared with Emory University and will be secured according to 
Emory IT policies. Only study personnel who are involved in the project will be allowed access 
to these data, and are also responsible for receipt or transmission of these data. If a participant 
declines to participate in all portions of the study, the participant will not be assigned a study ID 
number and the study coordinators/data collects will refrain from collecting any data on the 
participant.  If the participant agrees to participate in some portions of the study by not others, 
the participant will be assigned a study ID number and the study coordinators/data collectors will 
be instructed to collect data only on those aspects of the study to which the participant has agreed 
to participate.  These procedures will help prevent unauthorized inclusion of the patient’s data in 
the database. 
 
19. Provisions to Monitor the Data to Ensure the Safety of Participants
All procedures in this research are minimal risk.
20. Provisions to Protect the Privacy Interest of Participants
Participants will only interact with at most two study personnel during their visits. No personal 
information, beyond the information from the screening forms discussed above (attached), will 
be asked. 
21. Economic Burden to Participants
None.
22. Informed Consent 
All participants will provide informed consent by reading and signing a consent form before any 
experiments begin. Informed consent will be sought and obtained from all participants at the 
Dilks Lab in the Psychology Department, by members of the research team, who have all 

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completed certified human subjects training. On the consent form, the risks, benefits and 
experimental procedures will be clearly explained. Any questions regarding the procedures will 
be answered fully. All subjects will be told that they are under no obligation to participate in the 
experiment and may freely withdraw at any time without consequence. All subjects will be given 
a copy of the consent form. Typical completion of the consent form process takes about 10 to 15 
minutes.
While subjects are receiving money compensation for participating, the experiments proposed 
here are purely voluntary and subjects are able to withdraw at any point while still receiving 
compensation. Subjects will not be impaired in any way that would render them unable to 
understand consent and testing procedures, or unable to make mature, informed judgments. All 
subjects will also be able to respond by pushing a button or describing what is seen, thus 
successfully being able to complete the experimental tasks.
We will not include any non-English-speaking participants in this study for several reasons. 
First, we do not have a TMS screening form in languages other than English, which is crucial for 
selecting eligible participants in our study. Second, we do not have a consent form in languages 
other than English. Third, the tasks involved in the rTMS part of the study, although somewhat 
simple, can get a bit tricky if the participant does not speak English. Thus, we need participants 
who are able to fully understand the taks to properly conduct the experiment. 
23. Setting
Data collection will occur at the Facility for Education & Research in Neuroscience (FERN), 
Psychology and Interdisciplinary Studies Building, #795, Emory University, 36 Eagle Row, 
Suite 180, Atlanta, Georgia 30322. 
Participants will be recruited via the subject pool database maintained by the Emory University 
Psychology Department. The database involves names and contact information of people who 
have agreed to participate in research for course credit (1 credit up to 60 minutes) or to be paid 
for their participation. However, the participants in this study will not receive credit, but rather 
will be paid $20/hour in cash. Additionally, participants may be recruited in the community and 
at Emory University by word of mouth. 
24. Resources Available
Again, participants will be recruited via the subject pool database maintained by the Emory 
University Psychology Department. This database contains hundreds of prospective participants, 
enabling the recruitment of about 38 partcipants highly feasible. Likewise, the Psychology 
Department at Emory University has all of the facilities necessary to conduct and complete the 
research, as described just below. Finally, all persons assiting with the research will be 
adequately trained by the PI on the protocol, research procedures, and their duties. 

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MRI and TMS: The Psychology Department has both its very own Siemens 3T magnetic 
resonance imaging (MRI) scanner, and TMS device, which are dedicated to research. In addition, 
we have a full-time director and technician for the center in which the scanner is housed, called 
the Facility for Education and Research in Neuroscience (FERN). Also in FERN is a mock 
scanner, which is especially important for training those participants who have never been in an 
MRI before. 
Laboratory of the Principal Investigator: The Dilks Lab in the Psychology Department is 
comprised of approximately 1000 square feet, and includes office space that can accommodate 
up to 6 full-time staff members (research assistants/ graduate students/postdocs), two behavioral 
testing rooms (one with a SR Research EyeLink 1000 Plus Eye Tracker), and a conference room. 
The laboratory is also equipped with a high-speed 6-core MacPro for imaging analysis, 4 MacAir 
laptops, a dedicated laptop for fMRI data acquisition, and three desktop work stations. All 
computers provide access to behavioral and neuroimaging analysis software, including Matlab, 
SPM 8/12, AFNI, FSL, SPSS, R and Python. Finally, my lab currently consists of four 
outstanding graduate students, who all have the full competency to collect and analyze fMRI, 
psychophysical, and TMS data.
25. Multi-Site Research When Emory is the Lead Site
This is not a multi-site study.
26. References
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