Emotional intelligence, emotions, and feelings of support staff working with clients with intellectual disabilities and challenging behavior: An exploratory study

Research in Developmental Disabilities 34 (2013) 3916–3923

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Research in Developmental Disabilities

Emotional intelligence, emotions, and feelings of support staff working with clients with intellectual disabilities and challenging behavior: An exploratory study Linda J.M. Zijlmans a,b,*, Petri J.C.M. Embregts a,b,c,d,e, Anna M.T. Bosman b,f a

Tilburg University, Tranzo, Tilburg, The Netherlands Consortium Coping LVB, The Netherlands Tilburg University, Department of Medical and Clinical Psychology, Tilburg, The Netherlands d HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen, The Netherlands e Dichterbij Kennisn@, Ottersum, The Netherlands f Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands b c

A R T I C L E I N F O

A B S T R A C T

Article history: Received 21 May 2013 Received in revised form 9 August 2013 Accepted 14 August 2013 Available online 10 September 2013

Working with clients who show challenging behavior can be emotionally demanding and stressful for support staff, because this behavior may cause a range of negative emotional reactions and feelings. These reactions are of negative influence on staff wellbeing and behavior. Research has focused on negative emotions of staff. However, a distinction between emotions and feelings has never been made in the research field of intellectual disabilities. Negative emotions and feelings may be regulated by emotional intelligence, a psychological construct that takes into account personal style and individual differences. The purpose of this study was to explore the relationship between emotional intelligence on the one hand and emotions and feelings on the other. Participants were 207 support staff serving clients with moderate to borderline intellectual disabilities and challenging behavior. Emotional intelligence, emotions, and feelings were measured with questionnaires. The results show that emotional intelligence, emotions, and feelings are related. However, found relationships were weak. Most significant relations were found between feelings and stress management and adaptation elements of emotional intelligence. Because the explored variables can change over time they call for a longitudinal research approach. ß 2013 Elsevier Ltd. All rights reserved.

Keywords: Staff Challenging behavior Emotions Feelings Emotional intelligence

1. Introduction Challenging behaviors such as aggression and self-injurious behavior are a common phenomenon in care for people with intellectual disabilities (Wallander, Koot, & Dekker, 2003). Consequently, support staff are often confronted with challenging behavior. Therefore, working with clients who show challenging behavior can be emotionally demanding and stressful for staff, because it may cause a range of negative emotional reactions, such as fear, anger, and disgust (Bromley & Emerson, 1995; Hastings, 1995; Hatton, Brown, Caine, & Emerson, 1995). These emotions may ultimately lead to burnout and they may be reinforced by the persistent nature of challenging behavior of clients with intellectual disabilities, the lack of an effective manner to handle such behavior, and difficulties understanding this behavior (Bromley & Emerson, 1995).

* Corresponding author at: Tilburg University, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands. Tel.: +31 654950902. E-mail address: [email protected] (Linda J.M. Zijlmans). 0891-4222/$ – see front matter ß 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ridd.2013.08.027

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Additionally, negative emotions may also affect staff behavior, which in turn may lead to less assistance and less positive interactions (Rose, Jones, & Fletcher, 1998). Oliver (1995) described how negative emotions can actually cause patterns of avoidance within interactions with clients who show challenging behavior. A model developed by Weiner (1985, 1986), translated for the care for people with intellectual disabilities, states that inadequate beliefs with regard to challenging behavior can lead to negative emotions. These emotions decrease the chance of supporting staff behavior towards the client (Dagnan, Trower, & Smith, 1998; Hill & Dagnan, 2002; Weiner, 1985). In terms of interpersonal style, research has shown that experiencing negative emotions is an important predictor of a hostile and controlling style (Zijlmans, Embregts, Bosman, & Willems, 2012). In sum, negative emotions may negatively impact wellbeing and behavior of support staff. Although the effects of challenging behavior of clients on staff emotions appear to be well established, the role of feelings, a closely related aspect of affect development has not received the attention that emotions have (Hastings, 2002; Rose & Rose, 2005). In general, emotions and feelings are treated the same (Mitchell & Hastings, 1998). Since the seminal works by Damasio (1994), Damasio, Everitt, and Bishop (1996), and Damasio et al. (2000), it has become clear that emotions and feelings albeit related have different meanings. The subtle details between emotions and feelings as described by Damasio et al. (1996) will not be outlined here, but the most important distinction will be. Emotions, also called primary or basis emotions, are present in very young children (Ekman, 1992). Limited cognitive processes are involved in experiencing the six primary emotions of anger, disgust, fear, joy, sadness, and surprise (Ekman, Friesen, & Ellsworth, 1972). Feelings or secondary emotions, always involve aspects of cognitive and conscious processes (Damasio, 2001; Hansen, 2005). Feelings develop when a child grows up, interacting with his/her responsive parents. A responsive and sensitive parent provides security for the child and helps the child to regulate primary emotions, such that an adequate transition from emotions to more cognitive based, unique and personal feelings is established (Derksen, 2007). In addition, Damasio (2001) describes that feelings are a subjective matter whereas emotions are not. Emotions are objectively observable processes within the human brain and body. When dealing with challenging behaviors, staff members can experience primary emotions such as fear, but also feelings such as helplessness (Bromley & Emerson, 1995; Mitchell & Hastings, 1998). This distinction between emotions and feelings allows exploration of the effect of challenging behavior on basic emotions and more cognitive and reflective feelings, which may shed more light on the way staff’s primary emotions are transposed to personal feelings. Emotions can be viewed as temporary, unchangeable and affected or even caused by the situations in which the person finds his or her self. When reflecting on those emotions, one could say that the individual translates experienced emotions into feelings. For example, support staff who was reflecting on an aggressive incident with a client said: ‘‘He slapped me in my face, I got really frightened. The unpredictability of his behavior made me feel helpless.’’ In this quote fear is the emotion, helplessness the feeling. The emotion vanishes after the incident, whereas the feeling does not. It is quite conceivable that every time the staff member reflects on this incident or other incidents with this client, he feels helpless. Apart from the effect of negative emotions and feelings on the behavior of support staff, staff behavior is also affected by the way they regulate their emotions. An important predictor of emotion regulation is emotional intelligence. The general definition of this non-cognitive form of intelligence include elements of emotion regulation like ‘‘understanding one’s emotions’’ and ‘‘managing one’s own emotions and emotions of others’’. Bar-On (1997) defined emotional intelligence as ‘‘. . .an array of emotional, personal and social abilities and skills that influence an individual’s ability to cope effectively with environmental demands and pressures’’ (Bar-On, Brown, Kirkcaldy, & Thome´, 2000, p. 1108). Emotional intelligence addresses the following key factors: The perception people have of themselves and their emotions, how they assert their own desires and rights, the ability to understand and manage their own emotions and the emotions of others, relationships people have with others, the extent to which they invest in other people and in themselves, the ability to recognize and respect feelings of others, the strategies people use to handle problems, general well-being, and the capacity to control impulses. Emotional intelligence is a predictor of general functioning and wellbeing (Mayer, Caruso, Salovey, & Sitarenios, 2001). Van der Zee, Thijs, & Schakel (2002) showed that emotional intelligence predicted a significant amount of variance in academic and social success, above indicators of academic intelligence and personality. Birks and Watt (2007) proposed that emotional intelligence could affect patient-centred care, in which the ability to manage, read, and understand emotions and feelings of one self and one’s client is crucial. In addition, emotional intelligence can change over time (Goleman, 1995) and appears to be trainable (Freedman, 2003; Wasseveld, Overbeeke, & Derksen, 2007). Research has even shown that a training program focused on emotional intelligence related to treatment skills of support staff of clients with intellectual disability and challenging behavior is effective in improving emotional intelligence (Zijlmans, Embregts, Gerits, Bosman, & Derksen, 2011). Summarized, negative emotions and feelings of staff may be of negative influence on staff behavior and thus on the relationship between support staff and clients. Because feelings are more cognitive and reflective than emotions, regulating or changing feelings might be more effective than trying to regulate immediate emotions. In addition, coaching staff to regulate feelings with regard to challenging behavior of clients may lead to more adequate staff behavior and higher staff wellbeing, as they can reflect more neutrally on incidents with clients. Individual differences of emotion regulation are important when investigating staff emotions and feelings and finding pointers for staff training and coaching in order to improve staff behavior. Emotional intelligence addresses these individual differences and serves a broad and useful construct that could provide a significant contribution to the research field aimed at support staff working with individuals with intellectual disabilities and challenging behavior. In addition, past research on staff did not distinguish between emotions and feelings. Therefore, the main goal of this study is to explore the relationships among staff emotions, emotional

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intelligence, and feelings. The research question this study is aimed at is: is there a relationship between emotions, feelings, and emotional intelligence? Also, the relationship between gender, age, and work experience on the one hand, and emotions, feelings, and emotional intelligence on the other hand is considered. 2. Method 2.1. Participants The participants in this study were 207 staff members (151 women, 73%, 56 men, 27%) who were employed at four different residential treatment facilities in the Netherlands for children, adolescents, and adults with moderate to borderline intellectual disabilities and challenging behavior. The age of the participants ranged from 19 to 61 (mean = 32.87 years, SD = 9.27, median = 31) and their work experience with clients with intellectual disabilities and challenging behavior ranged from two months to 37.5 years (mean = 7.77 years, SD = 6.93, median = 6 years). The hours staff members worked a week ranged from 16 to 40 h (mean = 30.42, SD = 4.42, median = 32). Table 1 shows descriptive statistics of participants for each residential treatment facility. 2.2. Procedure In order to recruit participants, the experimenter first obtained permission from the management of the organizations to implement and conduct the research. Subsequently, the study was approved by the scientific and ethics committee of one of the four participating organizations, Dichterbij, in the Netherlands. Managers were provided with information about the main aims of the research project and together with the experimenter participants were randomly selected. All participants were working with children, adolescents, or adults with intellectual disabilities and challenging behavior. The experimenter contacted the staff to provide them with practical information about the research and after this each staff member received the questionnaires. The experimenter guaranteed confidentiality and anonymity to reduce the chance of social desirable responding. 2.3. Measures 2.3.1. Demographic information Participants obtained a general questionnaire on demographic characteristics like gender, age and work experience (see Table 1). 2.3.2. Emotional intelligence To measure emotional intelligence of staff members, the Dutch version of the Bar-On Emotional Quotient-inventory (EQi, Bar-On, 1997; Derksen, Jeuken, & Klein Herenbrink, 1998) was used. This instrument is widely used to measure emotional intelligence and it consists of 133 items using a five-point Likert scale with response categories ranging from 1 (very seldom true or not true of me), 2 (seldom true of me), 3 (sometimes true of me), 4 (often true of me), to 5 (very often true of me or true of me). The items constitute five scales concerning intrapersonal abilities, interpersonal skills, adaptability, stressmanagement capacity, and general mood. Examples of items are ‘‘I prefer others to make decisions for me’’, ‘‘I know how to deal with upsetting problems’’, and ‘‘I’m unable to understand the way other people feel’’.

Table 1 Descriptive statistics of participating staff. Facility 1

Facility 2

Facility 3

Facility 4

Gender Women Men

39 (70%) 16 (30%)

40 (78%) 9 (22%)

36 (68%) 16 (32%)

36 (71%) 15 (29%)

Age M SD Median

35.38 10.16 33

31.55 8.93 39

30.92 6.40 30

33.43 10.55 29

Work experience with people with ID and CB (months) M 10.04 SD 9.58 Median 6

6.75 5.07 5.5

7.25 4.97 7

6.85 6.40 4.58

Contract (hours a week) M SD Median n

30.88 4.38 22 51 (24%)

30.15 3.49 32 53 (25%)

30.06 4.01 32 51 (26%)

30.60 5.53 32 55 (26%)

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Table 2 Converted subscales staff emotions and feelings. Emotions

Feelings

Angry Sad Disgusted Frightened Afraid

Betrayed Humiliated Hopeless Resigned Helpless Frustrated Guilty Nervous Incompetent Shocked

Considerable support for the reliability and validity of the EQ-i is provided by several studies (Bar-On, Brown, Kirkcaldy, & Thome´, 2000; Dawda & Hart, 2000; Reiff, Hatzes, Bramel, & Gibbon, 2001). The construct validity has been examined in 16 countries and the EQ-i has been found to map a broad range of related emotional constructs (Bar-On, 1997; Derksen, Kramer, & Katzko, 2002). The mean Cronbach alpha coefficients for the different subscales range from .69 to .86. The average test–retest reliability coefficients after one and four months were .85 and .75, respectively. Empirical findings presented in the manual of the instrument show that the EQ-i is a reliable and valid instrument. The structural properties of the instrument have shown to be good (Dawda & Hart, 2000). The internal consistency of the EQ-i scores (total EQ-i) in this study was excellent (a = .82). 2.3.3. Experienced emotions and feelings To measure staff negative emotions and feelings when confronted with challenging behavior of their clients, the Emotional Reactions to Challenging Behavior Scale was used (Mitchell & Hastings, 1998). The questionnaire was translated into Dutch and checked by a native speaker. The scale comprises 15 4-point Likert items with response categories from 0 (no, never), 1 (yes, sometimes), 2 (yes, frequently) to 3 (yes, very frequently). Participants may rate to what extent they experience certain emotions and feelings when confronted with or dealing with challenging behavior. The questionnaire is originally composed of two distinct subscales, namely: fear/anxiety and depression/anger. The subscales with regard to negative emotions have a high internal consistency and a good test–retest reliability (Mitchell & Hastings, 1998). To get insight into emotions and feelings of staff members, the experimenter converted two new subscales from the items of the questionnaire, namely ‘‘emotions’’ and ‘‘feelings’’. Table 2 shows which items belong to which subscales. The alpha values for these subscales were .65 (emotions) and .66 (feelings). To obtain a mean score for the two subscales all scores on items belonging to a subscale were averaged. It should be noted that the data used in this study originally belong to a large intervention study, in which 210 support staff completed questionnaires before and after a training program (manuscript in preparation). In this study data of the pretest phase of 207 staff members were used. Three staff members did not complete the EQ-i, so they were discarded form the study. With respect to missing items in the Emotional Reactions to Challenging Behavior Scale, there were very few, that is, 8 out of 3105 (less than .3%). Apart from the fact that means were used, these few missings cannot have affected the outcomes in any way. 2.4. Design and analyses A within-groups correlational design was adopted in this study. First, means and standard deviations for all variables were calculated to describe our sample. Next, a correlational analysis was conducted to investigate the relationship between emotional intelligence on the one hand, and emotions, and feelings on the other. 3. Results In Table 3 the means and standard deviations of the staff with regard to the subscale scores of the questionnaires are presented. A Kolmogorov–Smirnov test was performed on the five main scales of the EQ-i, emotions, and feelings. Only interpersonal EQ-i, stress management, and adaptation were normally distributed. Because not all variables were normally distributed (p < .05), Spearman correlations were calculated. In Table 4 the Spearman correlations between the different scales are presented. To interpret the magnitude of the correlation coefficients, Cohen’s criteria (1988) were used, with correlations between 0.1 and 0.3 judged as small or weak, correlations between 0.3 and 0.5 as medium or moderate and correlations between 0.5 and 1.0 as large or strong. Only significant correlations are discussed here. It should be noted that the correlation between emotions and feelings was .59 (p < .001). The magnitude of this correlation indicates that the subscales of emotions and feelings are related, but do not measure the same construct. The results revealed that half of the correlations reached significance, but their magnitude is weak. Emotions as well as feelings correlated significantly with stress management and adaptation. Feelings are also significantly related to Intrapersonal EQ. Adaptation and stress management seemed most important when relating emotional intelligence to

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Table 3 Mean scores and standard deviations for measures. Mean

SD

Emotional intelligence Intrapersonal EQ Self-regard Emotional self-awareness Assertiveness Independence Self-actualization

104.45 101.15 105.13 105.81 102.87 101.86

12.66 11.84 12.84 13.98 13.73 11.91

Interpersonal EQ Empathy Social responsibility Interpersonal relationships Stress management Stress tolerance Impulse control Adaptation Reality testing Flexibility Problem solving General mood Optimism Happiness Emotions Feelings

104.54 101.09 101.73 106.16 108.07 106.24 106.88 103.33 106.04 101.62 98.84 104.49 103.41 104.68 .42 .54

11.79 12.55 12.84 11.03 10.49 10.84 11.83 13.37 12.93 14.56 14.45 10.95 12.42 10.22 .34 .29

Table 4 Spearman correlations between the scales of emotional intelligence, emotions, and feelings. Emotions Scales emotional intelligence Intrapersonal EQ Interpersonal EQ Stress management Adaptation General mood

.07 .11 .22** .15* .02

Feelings .23** .08 .18* .20** .07

n = 207. * p < .05. ** p < .001.

emotions and feelings. In other words, support staff who score higher on adaptation and stress management experience fewer negative emotions and feelings when confronted with challenging behavior. To obtain a more detailed picture, correlations among emotional intelligence, emotions, and feelings were also calculated for each subscale of the Bar-On EQ-i. These results are presented in Table 5. Again, it should be noted that although the following relationships were significant, they were all of weak magnitude. For the intrapersonal EQ subscales the following correlations were significant: the correlation between emotional selfawareness and feelings, the correlation between assertiveness and feelings, and the correlation between independence and feelings. Support staff with better insight into their own emotions, are more assertive, can express their emotions and cognitions more adequately, are more emotionally independent of others in life, report less negative emotions and feelings when dealing with challenging behavior of clients. Again, subscales of the stress management scale en the adaptation scale appeared to play the largest role with regard to experienced emotions and feelings when dealing with challenging behavior. Individuals who scored higher on impulse control, reality testing, and problem solving experienced fewer negative emotions when confronted with client’s challenging behavior. Additionally, staff who scored higher on stress tolerance, and reality testing, reported fewer negative feelings when working with a client who exhibits challenging behavior. In sum, support staff who are better in regulating stress, are more able to delay gratification and control their emotions more adequately, are more flexible, solve problems in a more adequate way, and are more able to perceive themselves and their present environment (reality testing), experience less negative emotions and feelings when working with clients who show challenging behavior. Thus, support staff who are better stress managers and are more able to adapt to their environment and situations they are confronted with, are more able to regulate the negative emotions and feelings which are caused by challenging behavior of their clients. In addition to the relationships between emotional intelligence, emotions, and feelings, the relationship between these variables on the one hand, and age, working experience and contract (hours a week) on the other were investigated. It should be noted that a Kolmogorov–Smirnov test showed that age, working experience, contract (hours a week) were not normally distributed (p < .01). Spearman correlations were calculated and the results showed significant relationships between age

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Table 5 Spearman correlations between the subscales of emotional intelligence, emotions, and feelings. Emotions Subscales emotional intelligence Intrapersonal EQ Self-regard Emotional self-awareness Assertiveness Independence Self-actualization Interpersonal EQ Empathy Social responsibility Interpersonal relationships Stress management Stress tolerance Impulse control Adaptation Reality testing Flexibility Problem solving General mood Optimism Happiness

Feelings

.06 .09 .07 .06 .06

.13 .16* .22* .22** .11

.07 .10 .05

.03 .03 .14*

.07 .26**

.17* .11

.14* .01 .16*

.20** .12 .07

.03 .01

.09 .08

n = 207. * p < .05. ** p < .001.

and intrapersonal EQ (r = .21, p < .01), between working experience and intrapersonal EQ (r = .16, p = .03), the correlation between working experience and general mood marginally significant (r = .14, p < .05). The found significant correlations were of weak magnitude. There were no significant correlations between staff variables, emotions, and feelings. 4. Discussion The aim of the present study was to explore the relationships among staff emotions, feelings, and emotional intelligence of support staff. Although the correlations between emotions and feelings on the one hand and emotional intelligence on the other hand were not large, significant relationships were found between certain subscales of emotional intelligence and emotions and feelings. Stress management and adaptation skills of staff members appear to play the largest role in the relationship with emotions and feelings. Support staff who are more adequate problem solvers, seem to experience fewer negative emotions when confronted with challenging behavior of their clients. Also, staff who manage stress more adequately, handle stress in a more constructive way and adapt more easily to certain situations in daily life, report less negative feelings. Staff who have a higher impulse control and control emotions in a more effective way experience less negative emotions as well as feelings when dealing with challenging behavior. This also applies to staff, who are more able to validate their feelings and cognitions with external reality. This study also revealed significant relationships between age and intrapersonal emotional intelligence. Older staff scored higher on the intrapersonal subscale of the EQ-i. In addition, staff with more working experience also scored higher on intrapersonal EQ-i, which makes sense because age and working experience are strongly related. Future research should clarify whether age or working experience are determinants of emotional intelligence. As said, the correlations were of weak magnitude. Note that, only correlational analyses were performed. The results should not be interpreted in terms of causality. The correlations were not corrected for multiple statistical tests, but the observed effect sizes were reported (r) and thereby the focus was put on the strength of the relationships between variables rather than their significance (Nakagawa, 2004; Perneger, 1998). This revealed that relationships were not very strong, but it did show a certain pattern, revealing that emotional intelligence appears to be more strongly related to feelings than to emotions. More specific definitions of the subscales of the EQ-I clarifies the relationships with emotions and feelings. For instance, Bar-On (1997) defines impulse control as the ability to effectively and constructively control and manage one’s own emotions. In addition, reality testing is defined as the ability to objectively validate one’s own feelings and cognitions with external reality. This includes being able to assess the agreement between what is experienced and what objectively exists. As said, staff scoring high on the subscales impulse control and reality testing reported less negative emotions and feelings. These and the other relationships among emotional intelligence, emotions, and feelings underline the view of emotional intelligence as a form of emotion regulation, which is in line work conducted by Montes-Berges and Augusto (2007). They showed emotional intelligence to be related to aspects of emotional regulation and coping, such as an avoidance-based coping strategy (Oliver, 1995). Looking at the difference between correlations of emotional intelligence with emotions on the one hand and feelings on the other, it is notable that more aspects of emotional intelligence are significantly related to feelings than to emotions. For instance, three out of five subscales regarding intrapersonal EQ are related to feelings, none are related to emotions. Staff members who have better abilities to express themselves and are emotionally and practically more independent of others,

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experience fewer negative feelings when confronted with challenging behavior. The fact that feelings seem to be more related to emotional intelligence compared to emotions, may be explained by the cognitive and conscious nature of both feelings and emotional intelligence and the relatively stronger unconscious nature of emotions (Damasio, 2001). When support staff completed the EQ-i and the Emotional Reactions to Challenging Behavior Scale they had to reflect on their own emotions, feelings, and their own personal style. The latter two can be considered conscious processes that include processes of reflecting and thinking, whereas emotions refer to a direct physical reaction (Damasio, 2001; Hansen, 2005). An explanation for the low correlations and the rather low scores on the Emotional Reactions to Challenging Behavior Scale, might be a sign of socially desirable responding that may come with the use of self-report measurement (Lambrechts, Kuppens, & Maes, 2009). Wanless and Jahoda (2002) showed that staff members reported more positive than negative emotions in response to questions with regard to challenging behavior. Support staff may find it difficult to admit they experience negative emotions and feelings such as fear or anger when dealing with challenging behavior. This is illustrated by anecdotal information. A direct quote from a staff member was ‘‘I find it hard to answer that I experience fear when working with X (client) because my organization gives me the feeling that challenging behavior should be considered as normal and ‘part of the job’.’’ This quote also stresses the importance of taking into account the organizational environment and the support staff gain from their supervisors when investigating emotions and feelings of staff (Blumenthal, Lavender, & Hewson, 1998; Hatton et al., 1999). In addition, research has shown that emotions are observable reactions in the human brain and body that can be investigated with, for instance, physical measurements (Damasio, 2001). These kind of measurements should be taken into account in future research on the relationship between emotional intelligence and emotions. The low values of the significant correlations may be the result of staff members completing one questionnaire with regard to their personal style in daily life (EQ-i) and another with respect to the emotions and feelings they experience when working with one specific client who exhibits challenging behavior (Emotional Reactions to Challenging Behavior Scale). Completion of the EQ-i with regard to a specific situation with a specific client might have led to higher correlations with emotions and feelings. Future research should focus on the distinction between general measures and measures regarding specific situations and clients. The current study takes an important initial step in exploring and investigating the relationship among emotional intelligence, emotions, and feelings of support staff working with clients who show challenging behavior. Some limitations arise when analyzing the results. As said, the use of retrospective self-report can be seen as a limitation. Therefore future research should also focus on other ways to measure staff emotions, for instance observational or even physiological methods. Van Oorsouw, Embregts, and Sohier (2011) made a first attempt in developing an observational instrument to measure staff emotions, which could form a fundament for prospective research. Another line of research has shown that emotions, feelings, and emotional intelligence are not stable factors and can change over time (Goleman, 1995; Kuppens, Oravecz, & Tuerlinckx, 2010; Timmermans, Van Mechelen, & Kuppens, 2010). These findings call for a more longitudinal approach when investigating emotions, feelings, and emotional intelligence. Conflict of interest None declared. Funding The research was funded by ZonMw. ZonMw has not imposed any restrictions on free access to or publication of the research data. There was no conflict of interest for any of the authors. Disclaimer This study is part of a larger PhD intervention research focused on the effectiveness of a staff training. For this research, the ethics procedures have been followed and the standards governing research involving human participants in force in the country in which the research has been conducted have been met. The clients and/or their representatives gave permission to participate in this study by giving their written consent. The authors submitted the research proposal to the scientific and ethics committee of one of the participating facility and this was approved. Acknowledgements We thank clients and care staff of Dichterbij STEVIG, De La Salle, Vitree, and Ipse de Bruggen in The Netherlands for their participation. References Bar-On, R. (1997). Bar-On Emotional Quotient Inventory: Technical manual. Toronto, Canada: Multi Health Systems.

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