Early Warning Signs

  • Most schools are safe.  Fewer than one percent of all violent deaths of children occur on school grounds.
    Indeed, a child is far more likely to be killed in the community or at home.  However, no school is immune.
    The violence that occurs in our neighborhoods and communities has found its way inside the schoolhouse door. And while we can take some solace in the knowledge that schools are among the safest places for young people, we must do more. School violence reflects a much broader problem, one that can only be addressed when everyone--at school, at home, and in the community--works together.

    The 1997-1998 school year served as a dramatic wake-up call to the fact that guns do come to school, and some students will use them to kill. One after the other, school communities across the country-from Oregon to Virginia, from Arkansas to Pennsylvania, from Mississippi to Kentucky-have been forced to face the fact that violence can happen to them. And while these serious incidents trouble us deeply, they should not prevent us from acting to prevent school violence of any kind.

    There is ample documentation that prevention and early intervention efforts can reduce violence and other troubling behaviors in schools. Research-based practices can help school communities recognize the warning signs early, so children can get the help they need before it is too late. In fact, research suggests that some of the most promising prevention and intervention strategies involve the entire educational community--administrators, teachers, families, students, support staff, and community members--working together to form positive relationships with all children.

    If we understand what leads to violence and the types of support that research has shown are effective in preventing violence and other troubling behaviors, we can make our schools safer. We can frame our response to potential violence in two ways:

    What to look for--the early warning signs that relate to violence and other troubling behaviors.

    What to do--the action steps that school communities can take to prevent violence and other troubling behaviors, to intervene and get help for troubled children, and to respond to school violence when it occurs.

    Creating a safe school requires having in place many preventive measures for children's mental and emotional problems-as well as a comprehensive approach to early identification of all warning signs that might lead to violence toward self or others. The term "violence" as used in this booklet, refers to a broad range of troubling behaviors and emotions shown by students-including serious aggression, physical attacks, suicide, dangerous use of drugs, and other dangerous interpersonal behaviors. However, the early warning signs presented in this document focus primarily on aggressive and violent behaviors toward others. The guide does not attempt to address all of the warning signs related to depression and suicide. Nevertheless, some of the signs of potential violence toward others are also signs of depression and suicidal risk, which  should be addressed through early identification and appropriate intervention.

    All staff, students, parents, and members of the community must be part of creating a safe school environment:

    Everyone has a personal responsibility for reducing the risk of violence. We must take steps to maintain order, demonstrate mutual respect and caring for one another, and ensure that children who are troubled get the help they need.

    Everyone should have an understanding of the early warning signs that help identify students who may be headed for trouble.

    Everyone should be prepared to respond appropriately in a crisis situation.
    Research and expert-based information offers a wealth of knowledge about preventing violence in schools. The following sections provide information-what to look for and what to do-that school communities can use when developing or enhancing violence prevention and response plans.

What to Look For

  • Characteristics of a School That Is Safe and Responsive to All Children

    Well functioning schools foster learning, safety, and socially appropriate behaviors. They have a strong academic focus and support students in achieving high standards, foster positive relationships between school staff and students, and promote meaningful parental and community involvement. Most prevention programs in effective schools address multiple factors and recognize that safety and order are related to children's social, emotional, and academic development.

    Effective prevention, intervention, and crisis response strategies operate best in school communities that:

    • Focus on academic achievement.
    • Involve families in meaningful ways.
    • Develop links to the community.
    • Emphasize positive relationships among students and staff.
    • Discuss safety issues openly.
    • Treat students with equal respect.
    • Create ways for students to share their concerns.
    • Help children feel safe expressing their feelings.
    • Have in place a system for referring children who are suspected of being abused or neglected.
    • Offer extended day programs for children.
    • Promote good citizenship and character.
    • Identify problems and assess progress toward solutions.
    • Support students in making the transition to adult life and the workplace.

Principles for Identifying the Early Warning Signs of School Violence

  • There are early warning signs in most cases of violence to self and others--certain behavioral and emotional signs that, when viewed in context, can signal a troubled child. But early warning signs are just that-indicators that a student may need help.

    Such signs may or may not indicate a serious problem--they do not necessarily mean that a child is prone to violence toward self or others. Rather, early warning signs provide us with the impetus to check out our concerns and address the child's needs. Early warning signs allow us to act responsibly by getting help for the child before problems escalate. Unfortunately, there is a real danger that early warning signs will be misinterpreted. Educators and parents--and in some cases, students--can ensure that the early warning signs are not misinterpreted by using several significant principles to better understand them. These principles include:

    • Do no harm. There are certain risks associated with using early warning signs to identify children who are troubled. First and foremost, the intent should be to get help for a child early. The early warning signs should not to be used as rationale to exclude, isolate, or punish a child. Nor should they be used as a checklist for formally identifying, mislabeling, or stereotyping children. Formal disability identification under federal law requires individualized evaluation by qualified professionals. In addition, all referrals to outside agencies based on the early warning signs must be kept confidential and must be done with parental consent (except referrals for suspected child abuse or neglect).
    • Understand violence and aggression within a context. Violence is contextual. Violent and aggressive behavior as an expression of emotion may have many antecedent factors-factors that exist within the school, the home, and the larger social environment. In fact, for those children who are at risk for aggression and violence, certain environments or situations can set it off. Some children may act out if stress becomes too great, if they lack positive coping skills, and if they have learned to react with aggression.
    • Avoid stereotypes. Stereotypes can interfere with--and even harm--the school community's ability to identify and help children. It is important to be aware of false cues--including race, socio-economic status, cognitive or academic ability, or physical appearance. In fact, such stereotypes can unfairly harm children, especially when the school community acts upon them.
    • View warning signs within a developmental context. Children and youth at different levels of development have varying social and emotional capabilities. They may express their needs differently in elementary, middle, and high school. The point is to know what is developmentally typical behavior, so that behaviors are not misinterpreted.
    • Understand that children typically exhibit multiple warning signs. It is common for children who are troubled to exhibit multiple signs. Research confirms that most children who are troubled and at risk for aggression exhibit more than one warning sign, repeatedly, and with increasing intensity over time. Thus, it is important not to overreact to single signs, words, or actions. 

Early Warning Signs of Potential Violent Behavior

  • It is not always possible to predict behavior that will lead to violence. However, educators and parents--and sometimes students--can recognize certain early warning signs. In some situations and for some youth, different combinations of events, behaviors, and emotions may lead to aggressive rage or violent behavior toward self or others. A good rule of thumb is to assume that these warning signs, especially when they are presented in combination, indicate a need for further analysis to determine an appropriate intervention.

    The following early warning signs are presented with the following qualifications: They are not equally significant and they are not presented in order of seriousness. The early warning signs include:

    Social withdrawal. In some situations, gradual and eventually complete withdrawal from social contacts can be an important indicator of a troubled child. The withdrawal often stems from feelings of depression, rejection, persecution, unworthiness, and lack of confidence.

    Excessive feelings of isolation and being alone. Research has shown that the majority of children who are isolated and appear to be friendless are not violent. In fact, these feelings are sometimes characteristic of children and youth who may be troubled, withdrawn, or have internal issues that hinder development of social affiliations. However, research also has shown that in some cases feelings of isolation and not having friends are associated with children who behave aggressively and violently.

    Excessive feelings of rejection. In the process of growing up, and in the course of adolescent development, many young people experience emotionally painful rejection. Children who are troubled often are isolated from their mentally healthy peers. Their responses to rejection will depend on many background factors. Without support, they may be at risk of expressing their emotional distress in negative ways-including violence. Some aggressive children who are rejected by non-aggressive peers seek out aggressive friends who, in turn, reinforce their violent tendencies.

    Being a victim of violence. Children who are victims of violence-including physical or sexual abuse-in the community, at school, or at home are sometimes at risk themselves of becoming violent toward themselves or others.

    Feelings of being picked on and persecuted. The youth who feels constantly picked on, teased, bullied, singled out for ridicule, and humiliated at home or at school may initially withdraw socially. If not given adequate support in addressing these feelings, some children may vent them in inappropriate ways-including possible aggression or violence.

    Low school interest and poor academic performance. Poor school achievement can be the result of many factors. It is important to consider whether there is a drastic change in performance and/or poor performance becomes a chronic condition that limits the child's capacity to learn. In some situations--such as when the low achiever feels frustrated,   unworthy, chastised, and denigrated--acting out and aggressive behaviors may occur. It is important to assess the emotional and cognitive reasons for the academic performance change to determine the true nature of the problem.

    Expression of violence in writings and drawings. Children and youth often express their thoughts, feelings, desires, and intentions in their drawings and in stories, poetry, and other written expressive forms. Many children produce work about violent themes that for the most part is harmless when taken in context. However, an overrepresentation of violence in writings and drawings that is directed at specific individuals (family members, peers, other adults) consistently over time, may signal emotional problems and the potential for violence. Because there is a real danger in misdiagnosing such a sign, it is important to seek the guidance of a qualified professional--such as a school psychologist, counselor, or other mental health specialist--to determine its meaning.

    Uncontrolled anger. Everyone gets angry; anger is a natural emotion. However, anger that is expressed frequently and intensely in response to minor irritants may signal potential violent behavior toward self or others.

    Patterns of impulsive and chronic hitting, intimidating, and bullying behaviors. Children often engage in acts of shoving and mild aggression. However, some mildly aggressive behaviors such as constant hitting and bullying of others that occur early in children's lives, if left unattended, might later escalate into more serious behaviors.

    History of discipline problems. Chronic behavior and disciplinary problems both in school and at home may suggest that underlying emotional needs are not being met. These unmet needs may be manifested in acting out and aggressive behaviors. These problems may set the stage for the child to violate norms and rules, defy authority, disengage from school, and engage in aggressive behaviors with other children and adults.

    Past history of violent and aggressive behavior. Unless provided with support and counseling, a youth who has a history of aggressive or violent behavior is likely to repeat those behaviors. Aggressive and violent acts may be directed toward other individuals, be expressed in cruelty to animals, or include fire setting. Youth who show an early pattern of antisocial behavior frequently and across multiple settings are particularly at risk for future aggressive and antisocial behavior. Similarly, youth who engage in overt behaviors such as bullying, generalized aggression and defiance, and covert behaviors such as stealing, vandalism, lying, cheating, and fire setting also are at risk for more serious aggressive behavior. Research suggests that age of onset may be a key factor in interpreting early warning signs. For example, children who engage in aggression and drug abuse at an early age (before age 12) are more likely to show violence later on than are children who begin such behavior at an older age. In the presence of such signs it is important to review the child's history with behavioral experts and seek parents' observations and insights.

    Intolerance for differences and prejudicial attitudes. All children have likes and dislikes. However, an intense prejudice toward others based on racial, ethnic, religious, language, gender, sexual orientation, ability, and physical appearance--when coupled with other factors--may lead to violent assaults against those who are perceived to be different. Membership in hate groups or the willingness to victimize individuals with disabilities or health problems also should be treated as early warning signs.

    Drug use and alcohol use. Apart from being unhealthy behaviors, drug use and alcohol use reduces self-control and exposes children and youth to violence, either as perpetrators, as victims, or both.

    Affiliation with gangs. Gangs that support anti-social values and behaviors--including extortion, intimidation, and acts of violence toward other students--cause fear and stress among other students. Youth who are influenced by these groups--those who emulate and copy their behavior, as well as those who become affiliated with them--may adopt these values and act in violent or aggressive ways in certain situations. Gang-related violence and turf battles are common occurrences tied to the use of drugs that often result in injury and/or death.

    Inappropriate access to, possession of, and use of firearms. Children and youth who inappropriately possess or have access to firearms can have an increased risk for violence. Research shows that such youngsters also have a higher probability of becoming victims. Families can reduce inappropriate access and use by restricting, monitoring, and supervising children's access to firearms and other weapons. Children who have a history of aggression, impulsiveness, or other emotional problems should not have access to firearms and other weapons. 

    Serious threats of violence. Idle threats are a common response to frustration. Alternatively, one of the most reliable indicators that a youth is likely to commit a dangerous act toward self or others is a detailed and specific threat to use violence. Recent incidents across the country clearly indicate that threats to commit violence against oneself or others should be taken very seriously. Steps must be taken to understand the nature of these threats and to prevent them from being carried out.

Identifying and Responding to Imminent Warning Signs of Potential Violent Behavior

  • Unlike early warning signs, imminent warning signs indicate that a student is very close to behaving in a way that is potentially dangerous to self and/or to others. Imminent warning signs require an immediate response.

    No single warning sign can predict that a dangerous act will occur. Rather, imminent warning signs usually are presented as a sequence of overt, serious, hostile behaviors or threats directed at peers, staff, or other individuals. Usually, imminent warning signs are evident to more than one staff member--as well as to the child's family.

    Imminent warning signs may include:

    Serious physical fighting with peers or family members.

    Severe destruction of property.

    Severe rage for seemingly minor reasons.

    Detailed threats of lethal violence.

    Possession and/or use of firearms and other weapons.

    Other self-injurious behaviors or threats of suicide.

    When warning signs indicate that danger is imminent, safety must always be the first and foremost consideration. Action must be taken immediately. Immediate intervention by school authorities and possibly law enforcement officers is needed when a child:

    Has presented a detailed plan (time, place, method) to harm or kill others-particularly if the child has a history of aggression or has attempted to carry out threats in the past.

    Is carrying a weapon, particularly a firearm, and has threatened to use it.

    In situations where students present other threatening behaviors, parents should be informed of the concerns immediately. School communities also have the responsibility to seek assistance from appropriate agencies, such as child and family services and community mental health. These responses should reflect school board policies and be consistent with the violence prevention and response plan (for more information see Section 5).

What to Do

  • Prevention, Intervention and Response to Crisis Events

    Prevention: Characteristics of a Safe Physical Environment

    Prevention starts by making sure the school campus is a safe and caring place. Effective and safe schools communicate a strong sense of security. Experts suggest that school officials can enhance physical safety by:

    Supervising access to the building and grounds.

    Adjusting scheduling to minimize time in the hallways or in potentially dangerous locations. Traffic flow patterns can be modified to limit potential for conflicts or altercations.

    Conducting a building safety audit in consultation with school security personnel and/or law enforcement experts. Effective schools adhere to federal, state, and local nondiscrimination and public safety laws.

    Arranging supervision at critical times (for example, in hallways between classes) and having a plan to deploy supervisory staff to areas where incidents are likely to occur.

    Prohibiting students from congregating in areas where they are likely to engage in rule-breaking or intimidating and aggressive behaviors.

    Having adults visibly present throughout the school building. This includes encouraging parents to visit the school, after having logged their visit at the office.

    Staggering dismissal times and lunch periods.

    Monitoring the surrounding school grounds-including landscaping, parking lots, and bus stops.

    Coordinating with school resource officer or District Security personnel to ensure that there are safe routes to and from school.

    In addition to targeting areas for increased safety measures, schools also should identify safe areas where staff and children should go in the event of a crisis.

    The physical condition of the school building also has an impact on student attitude, behavior, and motivation to achieve. Typically, there tend to be more incidents of fighting and violence in school buildings that are dirty, too cold or too hot, filled with graffiti, in need of repair, or unsanitary.

    School communities that have undertaken effective school wide prevention approaches do the following things:

    Consistently and fairly enforce the District Conduct and Discipline Code.

    Ensure that the cultural values and educational goals of the community are reflected in the school rules. These values should be expressed in a statement that precedes the school rules.

    Be sure consequences are commensurate with the offense, and that rules are written and applied in a nondiscriminatory manner and accommodate cultural diversity.

    Make sure that if a negative consequence (such as withdrawing privileges) is used, it is combined with positive strategies for teaching socially appropriate behaviors and with strategies that address any external factors that might have caused the behavior.

    Include a zero tolerance statement for illegal possession of weapons, alcohol, or drugs. Provide services and support for students who have been suspended and/or expelled.

Intervention: Getting Help for Troubled Children

  • Prevention approaches have proved effective in enabling school communities to decrease the frequency and intensity of behavior problems. However, prevention programs alone cannot eliminate the problems of all students. Some 5 to 10 percent of students will need more intensive interventions to decrease their high-risk behaviors, although the percentage can vary among schools and communities.

    What happens when we recognize early warning signs in a child?

    The message is clear: It's okay to be concerned when you notice warning signs in a child-and it's even more appropriate to do something about those concerns. School communities that encourage staff, families, and students to raise concerns about observed warning signs--and that have in place a process for getting help to troubled children once they are identified--are more likely to have effective schools with reduced disruption, bullying, fighting, and other forms of aggression.

Principles Underlying Intervention

  • Our prevention and response plans consider both prevention and intervention. Through their administration, all staff have access to specialists trained in evaluating serious behavioral and academic concerns.

    Research or expert-based experience show the following principals have a significant impact on successful intervention:

    Share responsibility by establishing a partnership with the child, school, home, and community.

    Inform parents and listen to them when early warning signs are observed.

    Maintain confidentiality and parents' rights to privacy.

    Develop and maintain the capacity of staff, students, and families to intervene.

    Support students in being responsible for their actions.

    Simplify staff requests for urgent assistance.

    Make interventions available as early as possible.

    Use sustained, multiple, coordinated interventions.

    Analyze the contexts in which violent behavior occurs.

    Build upon and coordinate both internal school resources and District resources.

    Responding to Crisis: The Crisis and Unusual Occurrence Plan

    The District has developed and published a Crisis and Unusual Occurrence Manual to help administrators prepare for and respond to crisis situation following is an excerpt from the manual outlining the basic suggested procedures for responding to a crisis. Make sure you know what your role will be in a crisis situation.

Crisis Procedure Checklist

  • This checklist is a guide. Not all crisis situations will require each step. Some crises may call for steps not outlined here. While steps are generally listed in the anticipated order of occurrence, some steps may not occur, some may be done concurrently and some may, out of necessity, occur out of order, depending upon the specific situation.

    Crisis prevention and anticipation

    Establish emergency plans.

    Review and practice plans. Make sure staff is aware of emergency code words and their responsibilities during a crisis.

    Be aware of subtle or sudden changes in behaviors of students or others and get assistance to evaluate the threat and de-escalate the situation if possible. Apply the principals for recognizing early warning signs of potential violent behavior and imminent warning signs of potential violent behavior.

    Establish and practice proactive security measures.

    Practice fair, consistent enforcement of rules and disciplinary practices.

    General steps for crisis intervention and response

    Call 911 for emergency police, fire or medical response, if needed.

    Isolate the situation.

    Consider whether or not to implement closure procedures, evacuation procedures or shelter in place procedures. Consultation may be needed with School Management in non-emergency situations or closure situations. In implementing shelter in place or evacuation procedures, consider whether there is:

    danger to the staff or students.

    the need to protect students from witnessing upsetting events.

    there is a crime scene that should be protected.

    if, how and where students will be released to parents or guardians.

    Notify and assemble appropriate crisis response team.

    If necessary, assemble the team by use of a code word(s)

    Response team will vary according to need.

    The crisis team leader may request assistance of a district wide response team.

    If a district-wide team is needed, the Executive Director or School Safety and Security Department will handle those notifications.

    Notify the School Safety and Security Department.

    Determine if additional support is needed.

    Activate a command center if needed.

    Issue appropriate equipment:

    Know the location of needed equipment and how to use it.

    Identify witnesses and separate them from other persons and other witnesses, if possible.

    Coordinate responding emergency personnel or district personnel.

    Know where injured persons can be most easily triaged.

    Know how and where to direct responding fire or police personnel, using floor plans and maps.

    Direct police personnel to witnesses, if appropriate.

    Review facts and determine when and what (if any) information is to be shared with:




    Media (refer to policies KBCA, KBCF,KBCG).

    Identify Media liaison if necessary.

    Determine how and when the information is to be shared with staff/students in order to control rumors and provide factual information.

    Public Address Announcements.

    Written bulletins.

    Classroom presentations/discussions.


    Determine if it is best that no information be shared.

    Complete incident report forms.


    Convene the building or District crisis postvention team of psychologists and social workers. The Special Education Department, School Management or District Security can assist with this.

    Debriefing on daily basis.

    Hospital or home visits, if necessary.

    Review process, status of referred students.

    Prioritize needs.

    Provide follow up actions.

    Provide support to team members.

    Conclusion: A Checklist for Prevention, Intervention and Crisis Response

    What To Look For--Key Characteristics of Responsive and Safe Schools

    Does my school have characteristics that:

    __ Are responsive to all children?

    What To Look For--Early Warning Signs of Violence

    Has my school taken steps to ensure that all staff, students, and families:

    __ Understand the principles underlying the identification of early warning signs?
    __ Know how to identify and respond to imminent warning signs?
    __ Are able to identify early warning signs?

    What To Do—Prevention and Intervention: Getting Help for Troubled Children

    Does my school:

    __ Understand the principles underlying intervention?
    __ Make early intervention available for students at risk of behavioral problems?
    __ Provide individualized, intensive interventions for students with severe behavioral problems?
    __ Have school wide preventive strategies in place that support early intervention?

    What To Do--Crisis Response

    Does my school:

    __ Understand the principles underlying crisis response?
    __ Have a procedure for intervening during a crisis to ensure safety?
    __ Know how to respond in the aftermath of tragedy?

Tips for Parents

  • Parents can help create safe schools. Here are some ideas that parents in other communities have tried:

    Discuss the school's discipline policy with your child. Show your support for the rules, and help your child understand the reasons for them.

    Involve your child in setting rules for appropriate behavior at home.

    Talk with your child about the violence he or she sees-on television, in video games, and possibly in the neighborhood. Help your child understand the consequences of violence.

    Teach your child how to solve problems. Praise your child when he or she follows through.

    Help your child find ways to show anger that do not involve verbally or physically hurting others. When you get angry, use it as an opportunity to model these appropriate responses for your child-and talk about it.

    Help your child understand the value of accepting individual differences.

    Note any disturbing behaviors in your child. For example, frequent angry outbursts, excessive fighting and bullying of other children, cruelty to animals, fire setting, frequent behavior problems at school and in the neighborhood, lack of friends, and alcohol or drug use can be signs of serious problems. Get help for your child. Talk with a trusted professional in your child's school or in the community.

    Keep lines of communication open with your child-even when it is tough. Encourage your child always to let you know where and with whom he or she will be. Get to know your child's friends.

    Listen to your child if he or she shares concerns about friends who may be exhibiting troubling behaviors. Share this information with a trusted professional, such as the school psychologist, principal, or teacher.

    Be involved in your child's school life by supporting and reviewing homework, talking with his or her teacher(s), and attending school functions such as parent conferences, class programs, open houses, and PTA meetings.

    Work with your child's school to make it more responsive to all students and to all families. Share your ideas about how the school can encourage family involvement, welcome all families, and include them in meaningful ways in their children's education.

    Encourage your school to offer before- and after-school programs.

    Volunteer to work with school-based groups concerned with violence prevention. If none exist, offer to form one.

    Find out if there is a violence prevention group in your community. Offer to participate in the group's activities.

    Talk with the parents of your child's friends. Discuss how you can form a team to ensure your children's safety.

    Find out if your employer offers provisions for parents to participate in school activities.

Action Steps for Students

  • There is much students can do to help create safe schools. Talk to your teachers, parents, and counselor to find out how you can get involved and do your part to make your school safe. Here are some ideas that students in other schools have tried:

    Listen to your friends if they share troubling feelings or thoughts. Encourage them to get help from a trusted adult-such as a school psychologist, counselor, social worker, leader from the faith community, or other professional. If you are very concerned, seek help for them. Share your concerns with your parents.

    Create, join, or support student organizations that combat violence, such as "Students Against Destructive Decisions" and "Young Heroes Program."

    Work with local businesses and community groups to organize youth-oriented activities that help young people think of ways to prevent school and community violence. Share your ideas for how these community groups and businesses can support your efforts.

    Organize an assembly and invite your school psychologist, school social worker, and counselor-in addition to student panelists-to share ideas about how to deal with violence, intimidation, and bullying.

    Get involved in planning, implementing, and evaluating your school's violence prevention and response plan.

    Participate in violence prevention programs such as peer mediation and conflict resolution. Employ your new skills in other settings, such as the home, neighborhood, and community.

    Work with your teachers and administrators to create a safe process for reporting threats, intimidation, weapon possession, drug selling, gang activity, graffiti, and vandalism. Use the process.

    Ask for permission to invite a law enforcement officer to your school to conduct a safety audit and share safety tips, such as traveling in groups and avoiding areas known to be unsafe. Share your ideas with the officer.

    Help to develop and participate in activities that promote student understanding of differences and that respect the rights of all.

    Volunteer to be a mentor for younger students and/or provide tutoring to your peers.

    Know your school's code of conduct and model responsible behavior. Avoid being part of a crowd when fights break out. Refrain from teasing, bullying, and intimidating peers.

    Be a role model-take personal responsibility by reacting to anger without physically or verbally harming others.

    Seek help from your parents or a trusted adult--such as a school psychologist, social worker, counselor, teacher--if you are experiencing intense feelings of anger, fear, anxiety, or depression.