1 An Introduction to Workplace Well-being

“Success is not the key to happiness. Happiness is the key to success.

If you love what you are doing, you will be successful.”

Albert Schweitzer

Introduction

Who wants lead a wretched, miserable life? Nobody. People want to live well and have been interested in learning how to foster well-being for thousands of years, perhaps from the dawn of time. As Darrin McMahon (2006) explains in Happiness: A History, “[t]he pursuit of human happiness, it would seem, has been with us from the start” (p. 2). “Perhaps happiness is, was, and ever shall be the ultimate end in every time and place” (p. xiii).

But what is happiness? If we are interested in promoting well-being, should happiness be our primary goal? What about at work? Is workplace well-being synonymous with workplace happiness?

What is Workplace Well-being?

The study of well-being involves an attempt to understand human flourishing. Correspondingly, the study of workplace well-being involves an effort to understand human flourishing at work. This effort involves more than the mere alleviation of workplace distress. As Ellen Choi and I outlined in The Palgrave Handbook of Workplace Well-being (Gruman & Choi, 2020):

Traditionally, workplace well-being focused mainly on wellness programs designed to prevent employee illness and the associated costs by inhibiting the onset and progression of disease (e.g., Goetzel et al., 2014)…. In contrast to these early… ideas about workplace wellness that focused on reducing illness, a defining feature of well-being in contemporary discussions is that well-being is not the mere absence of ill-being (Diener, 1984; Keyes, 2007). The absence of illness or ill-being brings one to a point of normality or average functioning which does not equate to the presence of health or well-being.

So, as indicated in Figure 1, well-being can be thought of as not just the absence of illness or ill-being, but a state that moves beyond normal functioning to flourishing. Similarly, workplace well-being is not the mere absence of ill-being at work, but instead represents a state beyond average functioning that involves enhanced functioning (Wooten & Cameron, 2010).

Figure 1. Workplace Well-being is not the Mere Absence of Ill-being

Workplace Well-being E.g., Health, Flourishing, Thriving
Normal Functioning E.g., Average, Typical, Ordinary
Workplace Ill-being E.g., Illness, Stress, Anxiety

Academic investigations of workplace well-being can be considered to occur largely, but not exclusively, within the broad field or positive organizational studies. Gruman and Choi (2020) note that:

Research on workplace well-being has largely been subsumed within the subfield of positive organizational studies. Positive organizational studies includes positive organizational behavior which focuses on positively oriented employee strengths and capacities (Luthans, 2002), positive organizational scholarship which concentrates on “especially positive outcomes, processes, and attributes of organizations and their members” (Cameron et al., 2003, p. 4), and positive organizational psychology which emphasizes positive subjective experiences, traits, and institutions such as work organizations (Donaldson & Ko, 2010)…. Positive organizational studies builds on the more general field of positive psychology (PP), the aim of which is to stimulate a shift in focus from ameliorating the negative in life to building the positive (Seligman & Csikszentmihalyi, 2000). In organizations this perspective involves a shift in focus from problem solving (negative deviance) to abundance (positive deviance; e.g., Lavine & Cameron, 2012).

So, workplace well-being involves the study of personal, group, and organizational factors that allow individuals and organizations to move beyond “average” functioning in order to excel and flourish, and the area of investigation in which this research occurs is positive organizational studies.

The Contours of Workplace Well-being

How do we define workplace well-being? In some ways, there are significant challenges in defining it, just like there are challenges in defining leadership. In his seminal 1500-page tome on leadership, Bernard Bass (2008) suggests that trying to establish a single definition of leadership may be unproductive. As he puts it “the search for the one and only proper and true definition of leadership seems to be fruitless. Rather, the choice of an appropriate definition should depend on the methodological and substantive aspects of leadership in which one is interested” (p. 23).

The same can be said of well-being, both in general and at work. Although it can appear to be a fairly simple concept, the definition of well-being is actually hotly debated and selecting a single definition may not be helpful. People often think of well-being as just another word for happiness, so workplace well-being might just be considered happiness at work. However, some social scientists argue that the general term happiness is too vague and misleading and that the term “well-being” more precisely characterizes the qualities of a good life (e.g., Alexandrova, 2005; Diener, 1994). Others use the terms interchangeably (Lyubomirsky, 2001). So, what can we say about well-being in general and workplace well-being in particular that would help us understand what they mean? Instead of jumping in to proposing a definition, let’s first consider some of the contours of well-being.

1. There are Two Main Types of Well-being

Generally, social scientists distinguish between two primary forms of well-being – subjective well-being and eudaimonic well-being. As Gruman and Choi (2020) note:

Diener, Suh, Lucas, and Smith (1999) define subjective well-being (SWB) as “a broad category of phenomena that includes people’s emotional responses, domain satisfactions, and global judgments of life satisfaction” (p. 277). They also note that SWB represents an area of scientific investigation, not a particular construct. That said, SWB is most often measured using scales that assess satisfaction with life (Diener, Emmons, Larsen, & Griffin, 1985) and/or positive and negative emotions (e.g., Watson, Clark, & Tellegen, 1988), the latter specifically referring to the hedonic aspect of well-being. Indeed, contemporary perspectives of well-being often highlight positive psychological states (Burke, 2017). Wright and Huang (2012) suggest that employee well-being has three defining characteristics: 1) it is a phenomenological, involving subjective perceptions of wellness, 2) it involves the experience of predominantly positive emotions, and 3) it is best conceived as an aggregate, as opposed to narrow, assessment. Nonetheless, narrow aspects of well-being are often the focus of interest, as elaborated below.

Eudaimonic well-being (EWB) involves the development and actualization of individual potential (Ryff & Singer, 2008) and the exercise of virtue (Ryan & Deci, 2001). Within the eudaimonic tradition, it is recognized that pleasant emotions that characterize subjective well-being may not produce positive outcomes and may not generate wellness (Ryan & Deci, 2001). However, by acting in ways that realize one’s true self, or daimon, one enjoys an intense feeling of being alive, fulfilled, and authentic (Waterman, 1993). EWB is most commonly conceived and assessed using six dimensions: self-acceptance, positive relations with others, autonomy, environmental mastery, purpose in life, and personal growth (Ryff & Keyes, 1995). It is also sometimes measured by assessing the satisfaction of basic psychological needs that are considered necessary for growth (Deci & Ryan, 2001). Ryan, Curren and Deci (2013) suggest that satisfying the basic human needs for autonomy, relatedness, and competence is related to fulfilment of human potential and essential to well-being.

To simplify somewhat, the first major form of well-being is called subjective well-being and it has two main components. The first is a cognitive component that typically involves one’s overall assessment of one’s level of life satisfaction but can also include assessments of one’s satisfaction with specific areas of life, for example, one’s job. The second component involves emotions, usually referred to as “affect” which is a broader term that includes general moods. These emotions involve positive affect, such as excitement, that we generally like to experience, and negative affect, such as sadness, that we typically want to avoid. Importantly, research reveals that positive and negative affect are not two ends of a single continuum (Cacioppo, Gardner, & Berntson, 1999). This means that you can experience any level of positive affect at the same time that you experience any level of negative affect. For example, if you get fired from your job you may simultaneously experience anxiety about paying next month’s rent but also joy over not having to work with your disagreeable boss anymore.

The second primary form of well-being, called eudaimonic well-being, is more focused on doing well, than feeling well (Martela & Sheldon, 2019). Eudaimonic well-being is all about becoming who you truly are. At work, eudaimonic well-being gives employees a sense that the work they are engaged in provides “a special fit or meshing”, feelings of being “more complete or fulfilled” and that it is what they were “meant to do” (Waterman, 1993, p. 682). A work-related construct that reflects eudaimonic well-being is employee engagement which refers to the extent to which people bring their “full selves” to their work roles (Kahn, 1990).

2. Well-being Can be Considered as Multidimensional or Unidimensional

Some forms of well-being are multidimensional in that they involve a number of components. For example, subjective well-being involves people’s emotions plus their overall satisfactions (Diener et al., 1999). For this reason, subjective well-being may be best thought of as an area of investigation as opposed to one specific “thing” (Diener et al., 1999).  Similarly, as noted above, eudaimonic well-being is often thought of as being made up of six dimensions. A multidimensional form of workplace well-being is psychological capital, which is made up of hope, optimism, self-efficacy (confidence) and resilience (Luthans & Youssef-Morgan, 2017).

Keyes (2002) presents another multidimensional approach to well-being. He distinguishes among emotional, psychological, and social well-being, which together represent flourishing. Emotional well-being refers to the level of positive affect people experience. Psychological well-being refers to eudaimonic well-being, and social well-being refers to how much people are thriving in their personal lives. An important aspect of Keyes approach is that it includes a social element that is absent from many other conceptualizations of well-being, and suggests that people need to be successful in three complementary areas in order to flourish.

The point here is that well-being is sometimes thought of as involving multiple dimensions. This can be valuable, considering the complexity and diversity of life. It may be that “the good life” requires considering a number of indicators of well-being simultaneously, the same way that flying an airplane requires paying attention to multiple gauges at the same time.

3. There are Also Narrow Aspects to Well-being

In addition to the broad, inclusive conceptualizations noted above, well-being can be thought of as involving narrow, focused concepts (Wright, 2014). Narrow concepts such as optimism, positive affect, and vigor are often the focus of research in organizations. For example, Arnold, Turner, Barling, Kelloway and McKee (2007) found that employees who perceived their managers as transformational leaders enjoyed higher levels of positive affect at work. Figure 2 presents a sampling of some narrow concepts that can be considered aspects of well-being in general and workplace well-being in particular.

Figure 2. Narrow Aspects of Well-being

Trust Vigor Belonging Flow
Self-efficacy Self-esteem Optimism Learning
Positive emotions Negative Emotions Hope Meaning
Purpose Accomplishment Emotional Stability Relationships
Resilience Vitality Respect Joy
Gratitude Mindfulness Savouring Peace of Mind

One complication in studying well-being is that sometimes some of the components of the multidimensional form are studied individually as unidimensional constructs. For example, subjective well-being involves life satisfaction, positive affect, and negative affect, but these components are generally studied separately (Diener, 1994). Similarly, eudaimonic well-being includes six components which can be studied individually.

4. Well-being can be Understood as Applying to Different Domains

Some forms of well-being are general and refer to broad areas of life. For example, life satisfaction, which is a component of subjective well-being, involves the extent to which you are satisfied with your life in general. Similarly, positive affect, another component of subjective well-being involves your overall level of positive emotions, not directed at any particular target.

By contrast, some forms of well-being are domain specific. For example, job satisfaction is a form of well-being that clearly pertains to the domain of work. Similarly, as we noted earlier, employee engagement is a form of well-being that involves bringing one’s full self to one’s work roles (Kahn, 1990). Another example is the notion of thriving which can be considered “the psychological state in which individuals experience both a sense of vitality and sense of learning at work” (Spreitzer, Sutcliffe, Dutton, Sonenshein, & Grant, 2005, p. 538). All these forms of well-being apply to the work domain, not the broad domain of one’s overall life, and are therefore examples of specific forms of workplace well-being.

We have also seen that some forms of well-being, such as life satisfaction are more cognitive in nature as they pertain to thoughts, whereas others, like positive affect, are more emotional in nature. Figure 3 presents a way to think about workplace well-being that integrates the ‘general versus specific’ and ‘cognitive versus emotional’ distinctions.

Figure 3. Well-being in Different Domains

Adapted from Warr, P. (2007). Work, Happiness and Unhappiness. New York: Lawrence Erlbaum Associates
Affective Focus Cognitive Focus
Broad Scope Moderate Scope Narrow Scope Broad Scope Moderate Scope Narrow Scope
E.g., Global affect E.g., Feelings about job E.g., Feelings about work colleagues E.g., Life satisfaction E.g., Job satisfaction E.g., Satisfaction with pay

Although the focus of this book is workplace well-being, we cannot ignore its broader forms. When you start your workday, you do not leave the rest of your life behind. Well-being at work should be understood within the larger context of general well-being because the two are related. For example, research has demonstrated that people who enjoy higher levels of general well-being tend to be more satisfied with their jobs (Boehm & Lyubomirsky, 2008; Wright & Cropanzano, 2000). So, if you want to understand someone’s level of workplace well-being it is a good idea to have some appreciation of their general well-being.

Interim Summary

It might seem discouraging that there is no consensus on a simple definition of well-being or workplace well-being. However, this should not be surprising as the need for a multifaceted approach to understanding well-being is similar to the state-of-affairs in other areas. Consider physical health. It would be silly to think that physical health could be reduced to one simple index such as blood pressure, cholesterol level, or resting heart rate. Instead, understanding physical health requires considering a combination of numerous indices that together reveal how healthy someone is. Well-being and workplace well-being are the same. Each of the different conceptualizations of well-being discussed above represents one indicator, which together can reveal someone’s overall well-being or workplace well-being.

In the same way that the various indices of physical health may be impacted by different treatments or activities, the different conceptualizations of well-being may be affected by different interventions or actions. For instance, practicing mindfulness may enhance the degree to which you enjoy positive emotions as work, but may also reduce your job satisfaction by highlighting your lack of fit with your job. Conversely, being given more responsibility may enhance your job satisfaction but also temporarily reduce your confidence as you struggle to perform your new duties. Thus, you can be high (or low) on one measure of well-being and low (or high) on another (Dolan, Kudrna, & Stone, 2017). Considering numerous forms of well-being enhances our understanding of well-being at work.

Building on Bass’s (2008) ideas about leadership that opened this chapter, the way in which we choose to define well-being should depend on the specific aspects of well-being in which we are interested. Bear this in mind as we meander through the various aspects of workplace well-being discussed in this book.

In the end, Bass (2008) capitulated and offered a tentative definition of leadership. We can do the same. If we would like to consider an overarching definition that brings the various conceptualizations together, we can think of well-being generally as “optimal psychological functioning and experience” (Ryan & Deci, 2001, p. 142). Similarly, building on this definition we can think of workplace well-being as “optimal psychological functioning and experience at work” (Gruman & Saks, 2013, p. 219).

Is Workplace Well-being Worth Studying and Promoting?

Workplace well-being is valuable for at least two reasons. First, people spend many hours over many years working, so understanding how to build organizations that foster well-being is an inherently worthwhile endeavor. In addition to making organizations effective we should try to make them “safe, just, healthy, challenging and fulfilling places in which to work” (Lefkowitz, 2019, p. 475). Zickar (2019) suggests that we need to stop justifying our efforts to improve the health and well-being of employees by appealing to measures such as profitability and productivity. Employee health and well-being is valuable in and of itself.

This argument notwithstanding, the second reason workplace well-being is worth studying is because it can foster job performance. For example, affective well-being has been shown to be associated with supervisor ratings of job performance (Wright & Staw, 1999). Research suggests that the correlation between job satisfaction and job performance is .30 (Judge, Thoresen, Bono, & Patton, 2001). We should also note that the relationship between well-being and performance appears to be bidirectional. Well-being seems to be associated with higher performance, but high performance can also contribute to well-being (Boehm & Lyubomirsky, 2008; Judge et al., 2001). At an aggregate level, other research suggests that the higher a nation’s well-being, the higher the country’s economic performance (DiMaria, Peroni, & Sarracino, 2020).

One thing that remains unclear is whether, and the degree to which, well-being relates to performance in all circumstances. Research has shown that the association between job satisfaction and performance is affected by other variables (Judge et al., 2001), but there is insufficient research available to be able to draw firm conclusions about the conditions under which well-being relates to performance or the variables that might alter the strength of this relationship.

The relationship between workplace well-being and performance may be constrained in work environments where behavior is driven primarily by external motivators rather than internal or interpersonal factors. For instance, workplace well-being may be weakly related to performance in sales jobs where behavior is driven more by the possibility of earning large bonuses or the fear of being fired than it is by one’s engagement with the job. There is a paucity of research on this topic, but it is something that warrants consideration.

A Balanced Approach to Workplace Well-being

This book presents a balanced approach workplace well-being based on The Balance Framework (Gruman, Lumley, & González-Morales, 2018). The Balance Framework explicitly elucidates that all positive phenomena have nuanced natures and conditions that determine when they are, and are not, advantageous. The framework recognizes that seemingly positive phenomena may have undesirable aspects, and that whether or not phenomena can be considered positive and desirable may depend on a variety of other things. To best understand positive phenomena such as well-being, The Balance Framework specifies five ways to consider balance: 1) balance as tempered view, 2) balance as mid-range, 3) balance as complementarity, 4) balance as contextual sensitivity, and 5) balance among different levels of consciousness. Each chapter in this book will present a discussion of at least one aspect of The Balance Framework to provide readers with a nuanced, sophisticated understanding of workplace well-being. Below, is a brief sketch of the individual elements of the framework.

For the interested reader, a more comprehensive discussion of the balanced approach to positive psychology can be found in Gruman, Lumley, and González-Morales (2018), and a discussion of The Balance Framework applied to workplace well-being can be found in Gruman and Choi (2020). See details in Reference section. Dr. Gruman’s TEDx talk on the balance framework can be found at this link.

Balance as Tempered View

Balance as tempered view highlights that phenomena that seem positive may also have negative features. For example, employee engagement is a form of workplace well-being that is associated with other desirable outcomes such as lower levels of stress, and higher life satisfaction and positive affect (Bailey, Madden, Alfes, & Fletcher, 2017). However, engagement has also been shown to interfere with employees’ family activities (Halbesleben, Harvey, & Bolino, 2009). We have to take the good with the bad.

Balance as Mid-range

Balance as mid range underscores that we can have too much of a good thing and that positive outcomes may be best promoted by experiencing more moderate levels of apparently positive phenomena. For example, optimism is a desirable quality that fosters effective coping, persistence, and physical health (Carver, Scheier, & Segerstrom, 2010). However, Hmieleski and Baron (2009) found that optimism among entrepreneurs was associated with poor new venture performance. The researchers reasoned that entrepreneurs who were too optimistic may have had unrealistic expectations, been overconfident, and discounted negative information which may have undermined their success. When it comes to desirable things, sometimes it is better to have a little than a lot.

Balance as Complementarity

Balance as complementarity highlights how different phenomena operate in tandem. For example, bravery seems like a desirable character strength that might promote well-being. However, without the associated quality of good judgment brave actions may be foolhardy and undermine well-being. The two operate in a complementary fashion. Similarly, Wright, Cropanzano and Bonett (2007) found that job satisfaction was positively associated with job performance, but only among employees who also had high levels of psychological well-being. These two well-being constructs operated synergistically. Considering one in isolation only tells part of the story.

Balanced as complementarity also recognizes that outcomes other than happiness can be considered as legitimate contenders for the ultimate goal of “positive” human activity at work. For example, it could be argued that autonomy is more important that happiness. Autonomy can be considered as “the ability to acquire a self-determined internal guidance in one’s life and actions, to be psychologically liberated from various internal and external pressures and demands, and to be able to attain internal peace, harmony, and tranquility because of this liberation” (Chirkov, 2017, p. 91). This is certainly more elaborate than just enjoying positive affect.

Perhaps wisdom is the ultimate condition for workplace health and well-being? We could even argue that wisdom should be considered the most important “positive” outcome at work despite the fact that cultivating wisdom might even sometimes compromise well-being (Weststrate & Glück, 2017).

Or perhaps workplace well-being involves a combination of these outcomes, in addition to others? At the outset of this chapter we asked the question: Is workplace well-being synonymous with workplace happiness? We can now answer this question in the negative: workplace well-being is not synonymous with workplace happiness. Put another way, the good life involves more than just the satisfaction and positive affect that characterizes subjective well-being (Diener, Suh, Lucas, & Smith, 1999). Workplace well-being requires a balance among numerous outcomes.

Another important aspect of balance as complementarity is an appreciation of the fact that workplace well-being is fostered by the combined effect of personal and situations forces. As Warr (2007) suggests “people at work are happier if their jobs contain features that are generally desirable and if their own characteristics and mental processes encourage the presence of happiness” (p. 2). If you have a sunny disposition but work for a tyrant, well-being may be harder to achieve. Conversely, if you have a great job, supportive boss, and friendly colleagues, but generally tend to see the glass as half empty, well-being may also be tougher to realize. Who you are as a person interacts with your job situation in determining workplace well-being. This means that you yourself are not entirely responsible for the level of well-being you experience at work.

Balance as Contextual Sensitivity

Balance as contextual sensitivity highlights that whether phenomena are considered desirable or not may depend on the situations in which they occur. For example, forgiveness is a virtue that is positively associated with psychological well-being, physical health, and positive relationships (McCullough, Root, Tabak, & van Oyen Witvliet, 2009). However, consistently forgiving an abusive supervisor may lead to the continuation or exacerbation of abusive behavior and undermine well-being. Therefore, forgiveness, like other seemingly positive constructs, can be either helpful or harmful, depending on the context in which it occurs (McNulty and Fincham, 2011).

Organizational context may also impact the drivers of organizational well-being. It has been shown that the relationship between ethical leadership and well-being in the form of job satisfaction is stronger in the public sector than the private sector (Bedi, Alpaslan, & Green, 2016). This may be because ethical leadership is not considered as desirable or “positive” in the private sector.

Cultural context is also important. For example, there are fundamental differences in Eastern and Western conceptualizations of happiness (Joshanloo, 2014) and approaches to well-being that are useful in one context may be less appropriate in another. Gruman and Choi (2020) explain that:

As Fineman (2006) suggests, it is necessary to be sensitive to variations in the cultural appropriateness of various emotional experiences and emotional display rules in order to properly understand what positivity means in particular environments. Happiness is not the main priority in many cultures (Ahuvia, 2001) and the appropriateness of expressing certain emotions varies cross-culturally. For example, Japanese employees score low on employee engagement (Shimazu, Miyanaka, & Schaufeli, 2010). However, this likely has less to do with Japanese workers reluctance to “bring their full selves” to their roles than it does with the cultural tendency for Japanese individuals to suppress positive affect (Shimazu et al., 2010). Additionally, the concept of the “self” differs across cultures (Kitayama, Markus, Matsumoto, & Norasakkunkit, 1997). Therefore, what it means to “bring one’s full self” to a role can vary in different cultures and have implications for workplace well-being concepts such as engagement and authenticity (Saks & Gruman, in press).

Limitations and Criticisms of Positive Organizational Studies

As part of adopting a balanced approach we want to acknowledge some limitations and criticisms of the study and practice of well-being and workplace well-being.

The first thing to consider is that the pursuit of well-being can sometimes undermine its occurrence. Specifically, trying to be happy can make you less happy. This can occur because of at least three problems: we set well-being standards that are too high and become disappointed when we don’t reach them; we pursue activities that are not effective in influencing well-being; or we become overly self-focused which undermines the experience of well-being (Ford & Mauss, 2014). Interestingly, there is evidence that this effect is limited to individualistic cultures. In more collectivistic cultures where well-being is pursued in more socially-engaged ways, its pursuit can be successful (Ford et al., 2015). Also, the form of well-being seems to matter. Whereas the pursuit of subjective well-being may often be unsuccessful or even counterproductive, pursuing eudaimonic well-being by focusing on helping, relationships, and personal growth, can be effective (Sheldon, Corcoran, & Prentice, 2019).

We also want to acknowledge that positive organizational studies and the promotion of workplace well-being have been criticized on a number of grounds. For example, Fineman (2006) argues that the eudaimonic idea of realizing one’s “true self” is inconsistent with modern notions of social construction that emphasize meaning-making and the creation of the self. He also suggests that positivity in organizations can become a form of tyranny that reinforces existing power structures and stigmatizes employees who fail to conform to the positive ideal. Warren (2010) echos this theme arguing that the positive turn in organizations is a form of oppression and exploitation in which employees are expected to work on their emotions in ways sanctioned by the organization. She suggests that in work environments in which “less-than-deal” states are considered undesirable working on oneself becomes normalized and expected. Behaviours that fall short of this ideal are then recast as deficient, and employees who do not want to strive for improvement are considered sick. This pathologizes what would otherwise be normal behavior, and undermines the spontaneous, natural experience of well-being.

Fortunately, the balance framework addresses some of these criticisms. For example, Fineman’s (2006) criticism that positive organizational studies inappropriately uncouples the positive and negative aspects of life is addressed by Balance as Tempered View and Balance as Complementarity. Nonetheless, we are wise to keep these criticisms in mind and consider how they can inform our understanding of workplace well-being, and its application.

Summary

Workplace well-being can be considered as optimal psychological functioning and experience at work. However, there are a number of ways in which this definition is qualified by the contours of well-being and the different forms well-being can take. A balanced perspective on workplace well-being allows us to adopt a sophisticated perspective on the topic and address a number of the criticisms leveled against it. Such a perspective helps us better understand the nature of workplace well-being and how to best promote well-being in ourselves and the people we work with.

But That’s Not All…

For those who prefer watching to reading and would like to learn more about workplace well-being, a somewhat different overview of the topic can be found in this webinar Dr. Gruman conducted on “Positive Psychology in the Workplace”.

 

Feedback

This book was written as an e-book partly to allow it to be a living document that can be updated on the fly. If you have any feedback on how this chapter can be improved please feel free to email Dr. Gruman at drjamiegruman@gmail.com

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