Crisis Response Planning

1. Introduction

Version followed: the Bryan–Rudd crisis response plan (CRP) as delivered in the Fort Carson trial (Bryan et al., 2017; standard CRP and enhanced CRP with reasons for living) and as taught in Craig Bryan's and his colleagues' training decks (eight-step sequence preceded by a narrative assessment). In those decks CRP is the Session 1 component of Brief Cognitive-Behavioral Therapy for suicide prevention (BCBT; Bryan & Rudd, 2018). The full trial methods paper and the BCBT book are not drawn on; procedure below comes from the authors' slide decks, the trial's companion paper (Bryan et al., 2018, Psychiatric Services) and the DoD clinician template that cites Bryan & Rudd (2010) [source: Bryan CRP deck; Bryan PREVENTS deck; Bryan et al. 2018; PHCoE CRP template].

CRP is a single, brief, collaborative intervention, not a full therapy. Patient and clinician first reconstruct the story of the most recent suicidal crisis. They then write a short personalised plan on an index card in the patient's own handwriting: warning signs, things to do alone, reasons for living, people to contact, and professional or crisis steps. The authors describe it as a memory aid for spotting emotional crises early, a checklist of personal strategies, a problem-solving tool, and "a collaboratively-developed strategy for managing acute periods of risk" [source: Bryan CRP deck]. It is explicitly not a no-suicide contract, no-harm contract or contract for safety. The press summary of the trial frames the contrast as a plan for "what to do" versus a contract's "what not to do" [source: ScienceDaily 2017]. Change idea: suicidal crises are time-limited periods of intense emotion. People are less likely to act on suicidal urges if they recognise the crisis early and have rehearsed, self-generated steps for riding it out, and if the conversation itself leaves them feeling understood. Reasons for living add positive emotion and optimism [source: MSRC CDE page; Bryan, Rozek et al. 2018 as summarised there].

2. Framework

CRP has no multi-session phases of its own. It is one session with a fixed internal sequence. It can stand alone (emergency or walk-in behavioural health visit, ED, primary care, intake), or it can open a longer treatment such as BCBT [source: MSRC CDE page; Bryan PREVENTS deck].

Format. One clinician, one patient, face to face. In the trial it was delivered in an emergency behavioural health appointment, before a blinded clinician decided on hospitalisation [source: Bryan et al. 2018]. Session length was not stated in any source [uncertain]. Allow roughly 30–60 minutes, including the narrative assessment [synthesis].

In-session stages, goals and criteria for moving on

Stage	Goal	Move on when
A. Engagement and narrative assessment	Hear the chronology of the index suicidal episode: events, thoughts, emotions, body sensations, behaviours	You have a moment-by-moment sequence from trigger to peak to resolution, and the patient appears to feel heard [source: Bryan, Baker, Rozek decks; criterion = synthesis]
B. Rationale and card	Explain what the plan is for, then hand over an index card and pen	The patient agrees to try building one [synthesis]
C. Build the plan (5 sections, in this order)	Warning signs → self-management → reasons for living → social supports → crisis/emergency steps	Each section has at least one concrete item the patient chose and wrote down [synthesis]
D. Verbal review and likelihood rating	The patient reads the plan aloud and rates how likely they are to use each step	Ratings are acceptable to both of you, with low-rated items revised or replaced. No threshold is published in the sources [uncertain]
E. Linkage	Lethal-means safety counselling, referral and follow-up appointment, plan for where the card will live	A follow-up appointment is booked and a means-safety plan is agreed [source: PHCoE template; PREVENTS deck]

Variants.

Standard CRP (S-CRP): risk assessment, supportive listening, crisis resources and referral, plus a card with warning signs, self-management skills and social support.
Enhanced CRP (E-CRP): adds an explicit discussion of reasons for living, which is also written on the card. In the trial the two did not differ [source: Bryan et al. 2018; ScienceDaily 2017].
Current training decks put reasons for living in as a standard step, so the eight-step sequence here includes it [source: Bryan CRP deck; Rozek deck].

Within BCBT. The plan is made in Session 1, alongside the narrative assessment and means-safety counselling. It is reviewed at the start of every later session, and continued use of the plan is treated as a marker of skill acquisition across the 10–12-session course [source: PREVENTS deck].

3. Guiding principles

A plan, not a promise. Never ask for a no-suicide commitment. The plan says what to do, not what not to do [source: Bryan CRP deck; ScienceDaily].
Collaborative. The patient generates the content and you prompt and shape it. Practical meaning: ask, don't prescribe; write their words, not your categories [source: Bryan CRP deck].
Built from the patient's own crisis story. Warning signs and strategies come from the narrative of the index episode, not a generic checklist [source: Bryan, Rozek decks].
Start from what has worked before. Mine past successes for strategies; this is the decks' main idea-generation tip [source: Bryan CRP deck].
Handwritten, small, portable. Use an index or business card, not a sheet of paper or a pre-printed fill-in form. Practical meaning: the patient holds the pen [source: Bryan CRP deck; Baker deck].
Self-management first, escalate stepwise. The order runs from self-help to people to professionals, which mirrors the "prioritised self-management" and "easy access to crisis services" ingredients [source: Bryan CRP deck citing Rudd et al., 2009].
Skills over talk. Effective interventions emphasise skills training, a simple model, clinician fidelity and patient adherence. Keep the plan simple enough to follow while distressed [source: Bryan CRP deck citing Rudd et al., 2009].
Empathy is an active ingredient. The plan's effect is reported strongest when the patient experiences the clinician as understanding and empathic, so supportive listening is part of the procedure [source: MSRC CDE page; Bryan et al. 2018].
Stay on the index episode. Keep the narrative focused on the recent suicidal episode rather than a full life history [source: Bryan CRP deck].
Accessible where crises happen. Copies and photos go wherever and whenever crises tend to occur [source: Rozek deck].
Test it before they leave. Read the plan back and rate the likelihood of use; an item the patient won't use gets changed [source: Bryan CRP deck].
Living document. Review and revise it at every later contact [source: PREVENTS deck].
Does not replace risk assessment or disposition decisions. CRP sits inside a full risk assessment, referral and follow-up [source: PHCoE template; Bryan et al. 2018].

4. Intervention inventory

Interventions 4.1–4.9 follow the authors' sequence: narrative assessment, then eight steps. Rationale and card (steps 1–2) are combined in 4.2. Items 4.10–4.13 are the linkage and follow-up components that the authors and the DoD template attach to CRP. Wording marked (illustrative) is mine. Short quoted prompts are verbatim from the training decks [source: Bryan CRP deck; Baker deck; Rozek deck; PREVENTS deck].

4.1 Narrative assessment of the index suicidal episode

Purpose / when: Always first. It builds rapport, gives the patient the experience of being understood, and supplies the raw material (triggers, early signs, what helped) for every section of the card [source: Bryan, Baker, Rozek decks].
Steps:
1. Invite the story of the most recent suicidal episode or attempt.
2. Let the patient tell it in chronological order, prompting forward rather than asking why.
3. At each point in the sequence, probe five channels: what happened (events), what they told themselves (thoughts), what they felt (emotions), what they noticed in their body (sensations), and what they did (behaviours).
4. Track the arc from first stressor, to escalation, to peak (ideation, preparation, attempt), to how the episode ended or eased.
5. Note anything that de-escalated it: a person, an activity, an interruption, a reason they stopped.
6. Keep it on the index episode. Summarise the sequence back to the patient [source: decks; step 5–6 detail = synthesis].
Example language: verbatim deck prompts: "Can you tell me the story of what happened?"; "What happened next?"; "What were you saying to yourself at that point?"; "Did you notice any sensations in your body at that point?" [source: Rozek deck]. Illustrative summary: "So it started with the call from your sergeant, then you went quiet, stopped answering texts, started drinking, and by midnight the thought was 'everyone's better off.' What made it ease off before morning?" (illustrative)
Watch for: Rising distress while retelling; slow down, ground, and summarise rather than push for detail [synthesis]. It is working if the patient talks more freely, corrects or adds to your summaries, and can name a sequence of signs. Do not collect method detail beyond what risk assessment and means-safety planning need [synthesis].

4.2 Explain the rationale and hand over the card (steps 1–2)

Purpose / when: Straight after the narrative. Explaining the purpose frames the plan as the patient's tool, not a form for the clinician [source: Bryan CRP deck].
Steps:
1. Link the plan to the story just told: crises build in steps and pass.
2. Say what the plan is: a short personal checklist for spotting a crisis early and knowing what to do.
3. Say what it is not: not a promise or contract.
4. Give the patient a blank index card or business card and a pen. Avoid paper sheets and pre-printed fill-in templates.
5. The patient does the writing [source: Bryan CRP deck; Baker deck; steps 1–3 wording = synthesis].
Example language: "What you've just described had a pattern: it built up over hours, and then it eased. I'd like us to write down, on this card, what you can do the next time you notice it starting, so you don't have to think it up in the middle of it. It's not a promise not to hurt yourself. It's a plan for what to do. You'll write it, in your words." (illustrative)
Watch for: The patient hearing "safety contract" and either agreeing compliantly or bristling. Re-emphasise that it is a practical tool you will build together [synthesis].

4.3 Identify personal warning signs (step 3)

Purpose / when: Gives an early-recognition cue, so the plan is opened before the peak [source: Bryan CRP deck].
Steps:
1. Return to the narrative and pick out the earliest points at which things started to change.
2. Elicit signs across channels: thoughts (e.g. hopeless or burden themes), emotions (e.g. anger, guilt, feeling trapped), body (e.g. agitation, insomnia) and behaviours (e.g. withdrawing, drinking). These example markers appear in the authors' "suicidal mode" slides.
3. Choose two to four signs that are specific, observable and early, and phrase them in the patient's words.
4. The patient writes them at the top of the card under a heading such as "Warning signs" [source: PREVENTS deck; PHCoE template lists behavioural, cognitive, affective or physical signs; selection rule = synthesis].
Example language: "Looking back at that night, what was the first sign, something you or someone else could have noticed, that things were heading downhill?" "When you start thinking 'what's the point,' is that early or late in the slide?" (illustrative)
Watch for: Vague signs ("stressed") or signs that only appear at the peak. Push for the earliest, most concrete version. It is working when the patient can say "when I notice X, I'll get out the card" [synthesis].

4.4 Identify self-management strategies (step 4)

Purpose / when: Things the patient can do alone to distract themselves, calm down or lower stress. This is the first line of response [source: MSRC CDE page; PHCoE template].
Steps:
1. Ask what has helped in the past, including in the index episode and earlier hard times.
2. Generate several options: activities, places, physical activity, music, relaxation or breathing, and self-care such as rest and avoiding alcohol and drugs.
3. Make each specific and doable at the times crises occur, including at night or alone.
4. Screen out anything that raises risk (e.g. drinking, driving fast, isolating) [synthesis].
5. The patient writes three to five strategies [source: Bryan CRP deck "what has worked in the past"; self-care examples from Firestone deck; item count = synthesis].
Example language: "When you've been really upset before and got through it, what did you do that helped even a little?" "If it's 2 a.m. and you can't sleep, which of these could you actually do?" (illustrative)
Watch for: Strategies that are aspirational rather than real, or that depend on a mood state the patient won't be in. It is working when the patient rates the items as likely and can picture doing them [synthesis].

4.5 Identify reasons for living (step 5; the enhanced-CRP element)

Purpose / when: Sources of meaning or purpose, written on the card. In the authors' follow-up analyses, discussing them was associated with increased positive emotion and optimism and less likelihood of hospitalisation [source: MSRC CDE page; Bryan et al. 2018].
Steps:
1. Ask directly what keeps them going or matters most to them: people, pets, faith, goals, roles, future events.
2. Explore at least one or two in some depth, so the patient connects with the emotion rather than listing.
3. The patient writes them on the card. The PHCoE template has a section for them.
4. The detailed E-CRP procedure for this discussion is not described in the sources [uncertain]. Steps 2 and 4 are synthesis [source: Bryan et al. 2018 for "explicit discussion"; PHCoE template].
Example language: "When things get this dark, what are the things, or people, that still matter to you?" "Tell me more about your daughter. What's she like? What do you want to be there for?" (illustrative)
Watch for: Reasons that trigger guilt or burden ("they'd be better off"). Reframe or choose a different reason. It is working if affect softens and the patient's speech becomes more future-oriented [synthesis].

4.6 Identify social supports (step 6)

Purpose / when: People who give emotional support or distraction, and who have helped before. Contacting them is the next rung after self-management [source: MSRC CDE page; PHCoE template].
Steps:
1. Ask who has helped in the past and whom the patient would actually feel comfortable contacting during a crisis.
2. Separate people for distraction ("let's get food") from people who can be told what is going on, if the patient makes that distinction.
3. Write names and phone numbers on the card.
4. Check practical access: is the person reachable at night, and would the patient really call or text? [source: PHCoE template; step 2 echoes the Stanley–Brown distinction on the Firestone slide and is not specified for CRP; steps 2 and 4 = synthesis].
Example language: "Who's someone you could text tonight, even just to talk about something else?" "Would you actually reach out to him, or is that someone you'd feel you were burdening?" (illustrative)
Watch for: Burden beliefs that block contact. Name them and pick someone the patient feels less burdensome to, or a low-demand contact such as a text. It is working when the patient names at least one reachable person and has the number [synthesis].

4.7 Provide crisis and emergency steps (step 7)

Purpose / when: The final rung, for when self-management and people have not been enough [source: Bryan CRP deck; PHCoE template].
Steps:
1. Write the treating clinician's or clinic's contact details and hours.
2. Add the 24/7 crisis line and text or chat options. The sources list the pre-2022 Lifeline and Veterans/Military Crisis Line numbers. In the US the current number is 988, and for Veterans and service members it is 988 then press 1, or text 838255 [synthesis: updated from current US service, not from CRP sources].
3. Add emergency steps: emergency number or nearest ED.
4. For service members, include the duty or command contacts the patient agrees to [source: PHCoE template; DoD template lists command coordination for military patients].
Example language: "If you've tried the things on your card and you still feel unsafe, this is the last step. Who do we write down: me, the clinic, the crisis line?" (illustrative)
Watch for: Reluctance to call crisis lines (fear of police, career or hospital consequences). Explore it and offer text or chat alternatives [synthesis].

4.8 Verbal review and likelihood-of-use rating (step 8)

Purpose / when: The final step in session. It checks that the plan is usable and rehearses it once [source: Bryan CRP deck].
Steps:
1. The patient reads the card aloud, top to bottom, as if a crisis were starting.
2. Ask them to rate how likely they are to use the plan, and each step.
3. Revise or replace low-rated items, and ask what would make them more likely.
4. Confirm the order: warning signs, then self-management, reasons for living, people, professionals.
5. The rating scale is not given in the sources [uncertain]. A 0–10 rating is a practical choice [synthesis].
Example language: "Read it to me as if it's 11 p.m. and you've just noticed you've stopped answering your phone." "On a scale of 0 to 10, how likely is it you'd pull this out? What would make it a 7 instead of a 4?" (illustrative)
Watch for: Uniformly high ratings given to please. Ask "what might get in the way?" It is working when the patient can explain when they would use each part [synthesis].

4.9 Making the plan accessible

Purpose / when: At the end of the session, so the card is at hand in a crisis.
Steps:
1. Suggest laminating the card or keeping it in a wallet.
2. Have the patient photograph it on their smartphone.
3. Make copies for places where crises tend to happen (bedside, car, locker).
4. Optionally pair it with the Virtual Hope Box app [source: Bryan CRP deck; Rozek deck].
Example language: "Where were you when it got worst last time? Let's make sure a copy lives there." (illustrative)
Watch for: Privacy worries about others seeing the card; discuss discreet headings [synthesis].

4.10 Lethal-means safety counselling (delivered alongside CRP)

Purpose / when: In BCBT Session 1 alongside CRP, and whenever there is access to firearms, stockpiled medication or other high-lethality means [source: PREVENTS deck; VA/DoD 2024 summary lists lethal-means safety].
Steps: The authors' deck uses four counselling phases from Britton, Bryan & Valenstein (2015) [source: PREVENTS deck].
1. Engaging: a collaborative, non-judgemental opening about the means.
2. Focusing: shift towards safety, balancing direction with patient choice.
3. Evoking: draw out the patient's own reasons to limit access, e.g. how they would want firearms stored if a family member were depressed or suicidal.
4. Planning: list options (off-site storage with a trusted person, locked storage with someone else holding the key, removing or limiting medication supplies), weigh pros and cons, and write the agreed plan down. Specific option list = synthesis.
Example language: verbatim deck opener: "I see here that you're a gun owner." [source: PREVENTS deck]. Illustrative evoking: "If your buddy were going through what you went through last week, what would you want him to do with his guns for a while?" (illustrative)
Watch for: Means are an identity or safety issue for the patient, especially service members and hunters. Emphasise temporary storage, not loss of ownership. Discuss storage and removal only, never method detail [synthesis].

4.11 Referral, follow-up and care coordination

Purpose / when: Before the patient leaves. These are minimum components of a CRP visit in the DoD template [source: PHCoE template].
Steps:
1. Book a follow-up appointment and any referrals.
2. For military patients, coordinate with command when appropriate, address stigma barriers, ensure follow-up through transitions, and enrol in local high-risk tracking.
3. Document the plan and keep a copy in the record [step 3 = synthesis].
Example language: "Let's get your next appointment on the calendar now, and I'll put it on the back of the card." (illustrative)
Watch for: A gap between the crisis visit and the next contact. Schedule within days where possible [synthesis].

4.12 Ongoing review and revision (when CRP opens a longer treatment)

Purpose / when: In BCBT, every session starts with reviewing the crisis response plan and homework. Lessons go into a treatment log. Effective use of the plan is one marker of skill acquisition before moving on [source: PREVENTS deck].
Steps:
1. At each session, ask whether warning signs occurred and whether the card was used.
2. Ask which steps helped or didn't.
3. Add new skills learned in therapy (e.g. relaxation or reappraisal skills) to the card, and retire ones that don't work.
4. Have the patient re-rate likelihood of use [steps 1–4 detail = synthesis from "reviewed each session"].
Example language: "Did any of your warning signs show up this week? Walk me through what you did with the card." (illustrative)
Watch for: The card is never used. See Section 5.

4.13 Adaptation for children and adolescents

Purpose / when: Youth patients [source: Baker deck].
Steps:
1. Decide the right level of caregiver involvement: more for children, negotiated with adolescents.
2. Use a collaborative stance with hard-to-engage youth.
3. Encourage the young person's ownership of the plan.
4. Address low confidence in using coping strategies, e.g. by rehearsing one in session.
5. Caregivers get a copy and a role in means safety at home [rehearsal and caregiver-copy specifics = synthesis].
Example language: "This is your plan, not your mom's. What do you want her to know about it?" (illustrative)
Watch for: The plan becoming a parental monitoring tool. Agree with the young person what is shared [synthesis].

Related BCBT components are not drawn on [uncertain]. BCBT also uses a commitment-to-treatment statement as its alternative to no-suicide contracts (Rudd, Mandrusiak & Joiner, 2006). It also uses a reasons-for-living list and a "survival kit" in its first phase. These sources are not drawn on. Consult Bryan & Rudd (2018) before using them; they are not part of standalone CRP.

5. Handling problems

The sources give almost no troubleshooting guidance. Unless a source is tagged, everything below is [synthesis] consistent with the CRP principles in Section 3.

Patient wants to skip the story, or you are under time pressure. Keep the narrative short but do not drop it; the plan's content comes from it. Ask for the last 24 hours before the crisis in three or four beats. The decks always place the narrative first [source: decks for ordering; brevity tactic = synthesis].
Overwhelm during the narrative. Pause, label the distress, and use brief grounding (feet on floor, slow exhale). Move to a later or less intense part of the timeline. Note the overwhelm itself as a warning sign or body sensation for the card. If the patient remains overwhelmed, move to the plan with what you have.
"I don't have any warning signs, it just happens." Slow the narrative down to hours before the peak and ask what others noticed. Use body sensations and behaviours (sleep, withdrawal, drinking), which are easier to spot than thoughts. Accept one provisional sign and plan to refine it at review.
"Nothing helps." Ask about the smallest thing that helped even slightly, or what they do when a friend is overwhelmed; the Rozek deck uses this reflection. Accept partial or distraction-only strategies. Test one in session, such as a breathing exercise or a short walk.
Strategies that raise risk (alcohol, drugs, isolating, driving, self-injury). Validate the function (relief) and explain that these increase risk in a crisis. Find a substitute with the same function. Do not write them on the card. Add avoiding alcohol and drugs as self-care [source: Firestone deck self-care list; rest = synthesis].
No social supports, or strong burden beliefs. Use low-demand contacts such as texting, online communities or a chaplain. Professional and crisis contacts can carry more of the plan. Treat isolation as a treatment target.
Reasons for living are absent or turn into guilt. Don't force them. Ask what used to matter, what they would want to be different, or small near-term reasons (a pet, an event next week). If a reason triggers "they'd be better off without me", address the burden belief directly rather than leaving it on the card. E-CRP did not outperform S-CRP in the trial, so a thin reasons-for-living section is not a failed plan [source: ScienceDaily; Bryan et al. 2018].
Low likelihood ratings. Ask what gets in the way and revise the item. If the overall rating stays low, explore ambivalence about the plan or about living. That is a risk-relevant finding to take into the disposition decision.
Clinician or system wants a safety contract. Explain that the authors explicitly distinguish CRP from contracts for safety, and that CRP outperformed one in the trial. Document the plan instead of a contract [source: Bryan CRP deck; ScienceDaily].
Patient refuses the plan or is mistrustful (fear of hospitalisation, career or legal consequences). Be transparent about confidentiality limits and what drives admission decisions. Offer to build the plan anyway as their own tool. Even a partial card is better than none. In military settings, address stigma and command-notification fears explicitly [source: PHCoE template on stigma barriers].
Acute intoxication, psychosis or mania. The trial excluded conditions that precluded informed consent [source: CDP Research Update]. Stabilise and ensure safety first, and build the plan when the patient can engage.
Imminent risk. CRP does not replace a disposition decision. Complete risk assessment and follow local emergency procedures. In the trial a separate clinician made the hospitalisation decision after the CRP [source: Bryan et al. 2018].
Non-adherence: card never used. At review, find out whether the patient didn't notice the warning signs, didn't have the card, or tried it and it didn't help. Fix that specific link: earlier signs, more copies or a phone photo, or better strategies. Rehearse use in session through imagery: "imagine it's starting now" (illustrative).
Card lost or used up. Remake it in session. Re-writing it by hand is itself rehearsal.
Repeated crises despite the plan. Treat the plan as a starting point and refer for, or continue, a suicide-specific treatment such as BCBT, CT-SP, CAMS or DBT. Use each crisis as a new narrative to refine the card [source: PREVENTS deck for BCBT and the alternatives listed; process = synthesis].
Rupture (the patient feels processed, judged or not heard). Name it, apologise for rushing, and return to listening. The authors' data suggest the effect depends on the patient feeling understood [source: MSRC CDE page]. Ask what would make the plan feel like theirs.
Telehealth. The patient writes the card at home while you watch, or you co-write a shared document. They send a photo for the record. Confirm their location and an emergency contact at the start. Telehealth delivery is not described in the sources [uncertain].
Firearm owners resisting means safety. Use the evoking phase: their own reasons, temporary storage options, and trusted people to hold firearms. Avoid confrontation [source: PREVENTS deck phases; specifics = synthesis].

Sources

Sources

Further reading (not drawn on) [uncertain where relied on]

Bryan CJ, Mintz J, Clemans TA, Leeson B, Burch TS, Williams SR, Maney E, Rudd MD (2017). Effect of crisis response planning vs. contracts for safety on suicide risk in U.S. Army soldiers: a randomized clinical trial. Journal of Affective Disorders, 212, 64–72. Only the abstract is drawn on.
Bryan CJ, Rudd MD (2018). Brief Cognitive-Behavioral Therapy for Suicide Prevention. Guilford Press.
Bryan CJ, Rudd MD (2010). Managing Suicide Risk in Primary Care. Springer.
Bryan CJ, Rozek DC, Burch TS, Leeson B, Clemans TA (2018). Psychiatry: Interpersonal and Biological Processes (reasons for living and emotional change after CRP).
Britton PC, Bryan CJ, Valenstein M (2016). Motivational interviewing for means restriction counseling with patients at risk for suicide. Cognitive and Behavioral Practice. Cited in the decks as 2015.
Rudd MD, Mandrusiak M, Joiner TE (2006). The case against no-suicide contracts: the commitment to treatment statement as a practice alternative. Journal of Clinical Psychology, 62, 243–251.
Rudd MD, et al. (2009). Essential ingredients of effective interventions, as cited in the Bryan decks.

Gaps. The CRP training site (crpforsuicide.com) and the full trial methods are not drawn on. The following were not given in any source: session length, the likelihood-of-use rating scale, the E-CRP reasons-for-living procedure, and telehealth guidance [uncertain].

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