Professional Psychology: Research and Practice 1998, W>l. 29. No. 2, 125-129 Copyright 1998 by the American Psychological Association, Inc. 0735-702OT8/$3.00 Self-Attention and Reported Symptoms: Implications for Forensic Assessment Christopher W. Williams and Paul R. Lees-Haley Lees-Haley Psychological Corporation J. Randall Price Richland College Does patient self-attention to physical and psychological symptoms compared to self-distraction result in different clinical conclusions in forensic contexts? Participants in 2 studies were instructed either to attend carefully to somatic symptoms and sensations (attention instructions), to tally how many questionnaire items were related to physical versus emotional symptoms (distraction instruc- tions), or received no attentional instructions (controls). The principal findings were that physical symptoms and reports of anxiety and depression were greater after attention instructions than after distraction instructions. Insofar as assessment contexts produce differential attention to self, examin- ers are advised to use caution in drawing conclusions regarding accuracy of self-reported symptoms. The accuracy of patient self-reports of symptoms have very different implications in forensic assessment than in psychother- apy. Although assessment skills of doctoral-level psychothera- pists appear transferable to forensic settings, there are funda- mental differences in orientation to clients when clinicians function as forensic examiners rather than as therapists (Greenberg & Shuman, 1997). One prominent difference lies in assumptions regarding the significance of inaccuracies in historical data and in symptoms reported by patients. Whereas the efficacy of psychotherapy usually is unaffected by such inac- curacies, the efficacy of psychological and neuropsychological assessment of patients in civil litigation can be undermined by self-reports that are distorted (Greenberg & Shuman, 1997). Clinicians unaccustomed to scrutinizing the veracity of patient self-reports in psychotherapy can be misled about patient status by accepting uncritically self-reports of litigants. Tb render impartial assessment, the forensic examiner needs to have self-reports that reflect authentic functioning of litigants, both current and pre-injury. Contextual variables of litigation, such as financial incentives to overreport current physical and psychological symptoms (Berry et al., 1995) or to underreport pre-injury difficulties (Lees-Haley et al., 1997) can influence CHRISTOPHER W. WILLIAMS received his PhD from the University of California, Los Angeles, in 1992. He is research director at Lees-Haley Psychological Corporation, Woodland Hills (Los Angeles), CA. His research interests include application of findings from social psychology in general, and social cognition in particular, to perception of illness and injury and to motivation to engage in litigation. PAUL R. LEES-HALEY earned his PhD from the University of Tennessee in 1978. He specializes in the evaluation and treatment of trauma victims. He is based in Woodland Hills (Los Angeles), CA, where he is president of Lees-Haley Psychological Corporation. J. RANDALL PRICE received his PhD from the University of North Texas in 1982. He is a professor of psychology at Richland College in Dallas, TX. His research interests lie in forensic psychology. CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Paul R. Lees-Haley, 21331 Costanso Street, Woodland Hills, California 91364. Electronic mail may be sent to plh@ix.netcom.com. self-reports. How the context of litigation can influence claim- ants' perceptions of physical and psychological symptoms is important to consider for fair assessment of injuries. Because of the protracted nature of litigation, plaintiffs are susceptible to stressors and influences that may lead to overreporting of symptoms (Weissman, 1990). One relatively unexplored way this overreporting might happen is through alteration of norma- tive information-processing activities. To be specific, litigation may promote extraordinary increases in attention or hypervigi- lance to somatic sensations and psychological states such that plaintiffs perceive and report greater severity in the frequency and intensity of symptoms than warranted. If the forensic exam- iner is insensitive to the role that heightened attention plays hi such distortion, competent forensic examination could be derailed. Social psychological research suggests that as attentional ca- pacities shift from a focus on external, environmental stimuli to internal, bodily states, misinterpretation of autonomic sensations and increases in self-reported symptoms can result (e.g., Du- val & Wicklund, 1972; Fillingim & Fine, 1986; Pennebaker, 1980, 1982; Pennebaker & Brittingham, 1982; Pennebaker & Lightner, 1980; Schachter & Singer, 1962; Wegner & Giuliano, 1980; see also reviews in Skelton & Croyle, 1991). This finding has important implications for how people in general, and liti- gants in particular, respond to both physical and psychological symptom inventories when attention is allocated more to one loci than to the other. Differential focus of attention could affect the rate at which signs of physical and emotional distress are reported on symptom inventories, with internal as opposed to external focus elevating their intensity and frequency. Inasmuch as litigation can be a lengthy process consisting of repeated physical and psychological examinations, depositions, attorney conferences, vigilance regarding status of symptoms, and the like, extraordinary attention to internal states can be an issue in forensic assessment. Two Explorations Relevant to Professional Practice Although previous research has implicated internal focus of attention in elevating the frequency of reported symptoms, these 125