Seeking help is one of the most consequential of health behaviours. Deciding to book a doctor’s appointment, disclose symptoms, attend therapy or adhere to treatment determines whether conditions are caught early, managed effectively or left to worsen. Yet, help-seeking is not a straightforward reflection of need. People do not track their symptoms with perfect accuracy or weigh their options rationally. Instead, their decisions are filtered through memory and memory is biased.

We have seen in this theme of articles on working memory that it is prone to systematic distortions. When people decide whether to seek help, they are not working with a complete history of symptoms. They are working with a compressed, biased sample: what is most recent, most vivid, most mood-congruent or easiest to summarise.

This article explores how core working memory biases like recency, salience, mood-congruence, averaging, interference, anchoring, omission, satisficing and social/self-schema effects shape help-seeking behaviours.

Recency Bias: The Last Few Days Drive Action

Recency bias means that the most recent experiences dominate recall.

• Delaying care: A patient with chronic but fluctuating pain may feel better in the last few days and decide not to book an appointment, even if the previous month was difficult.

• Rushing to care: Conversely, someone with mild but long-term symptoms may seek urgent care after a recent flare-up, even if the overall trend is stable.

Recency makes help-seeking volatile: the decision depends disproportionately on the most recent days rather than the long-term pattern.

Salience and Vividness: Health Scares as Catalysts

Vivid, emotionally charged episodes dominate memory and drive action.

• Trigger events: A panic attack, fainting spell or severe migraine may prompt immediate help-seeking, even if milder episodes were ignored for months.

• Neglected symptoms: Less salient but persistent problems, such as fatigue, stiffness and low mood, fade into the background and fail to prompt care.

Salience explains why people sometimes ignore chronic issues until a health scare makes the risk impossible to overlook.

Mood-Congruent Recall and Current State Bias

Mood and state at the time of decision strongly shape recall.

• Low mood: Depression makes negative experiences more accessible. On a bad day, someone may recall every failure, every symptom and feel overwhelmed, pushing them towards help, or paralysing them into avoidance.

• Good mood: in contrast, when feeling well, symptoms seem distant or trivial. A person may decide against seeking care, even if the overall pattern warrants it.

Mood-congruent recall creates instability: willingness to seek help rises and falls with state, not just with need.

Averaging and Neglect of Variability

People tend to simplify symptom histories into rough averages, smoothing out fluctuations.

• Underestimation: A patient with alternating good and bad weeks may report “moderate symptoms”, leading them to believe they can cope without help.

• Overgeneralisation: Someone with mostly good days but occasional severe episodes may average them into “sometimes bad” underplaying the peaks that need attention.

Averaging means variability, the very pattern that often signals risk, is masked. Help is delayed because the extremes vanish in the summary.

Interference and Overlap: Blurred Symptom Categories

When symptoms overlap, memory struggles to separate them.

• Physical versus mental: Fatigue, low mood, poor sleep and pain may blur together, making it unclear whether to seek help from a GP, a psychologist or no one at all.

• Similar descriptors: Patients confuse overlapping symptoms, “shortness of breath” versus “fatigue” and may dismiss one or double-count both.

Interference undermines clarity, leading to hesitation: if symptoms are blurred, it is harder to decide whether and where to seek help.

Anchoring to Extremes: One Encounter Defines the Future

Extreme episodes anchor perception and drive help-seeking behaviours.

• Negative anchoring: A dismissive doctor visit may define expectations and deter future help-seeking (“They never listen anyway”).

• Positive anchoring: A single helpful consultation may encourage ongoing engagement, even if subsequent experiences are mixed.

• Symptom anchoring: A patient may define their illness by one extreme episode (a seizure), ignoring the broader variability of symptoms.

Anchoring explains why help-seeking patterns often persist long after the initial episode: one extreme sets the reference point.

Omission: The Forgotten Everyday Struggles

Working memory drops routine, low-salience events.

• Chronic but mild symptoms: Everyday stiffness, fatigue or low mood may be forgotten when recalling reasons to see a doctor.

• Small declines: Gradual deterioration is omitted because each day feels much like the last. Only sudden drops are remembered.

Omission means that many people live with ongoing symptoms for years before seeking help, because the routine struggles never feel pressing enough to remember clearly.

Satisficing and Cognitive Shortcuts

When deciding whether to seek help is too demanding, people use shortcuts.

• “Wait and see”: Instead of evaluating the full symptom history, people default to postponing care until things get worse.

• Rule of thumb: “If it is not unbearable. It is fine.” Such heuristics conserve effort but delay care.

• Checklist thinking: People may compare their symptoms to a mental list of “serious signs” (haemorrhage, collapse) and if they do not match, dismiss the need for help.

Satisficing simplifies decision-making but at the cost of accuracy.

Social Desirability and Self-Schema Effects

Help-seeking is shaped by identity and social context.

• Social desirability: people downplay symptoms that feel stigmatising, especially in the areas of mental health, sexual health and substance use, and delay seeking help to avoid negative judgement.

• Self-schema: People recall experiences that fit their identity. Someone who sees themselves as resilient remembers coping, not suffering, and avoids seeking help. Conversely, someone who identifies as “sickly” recalls failures and is quicker to seek care.

These motivational biases inject self-image into the decision, distorting whether and when help is sought.

What Does This Mean?

Taken together, the biases show why help-seeking is so inconsistent:

• Short-term distortions: Recency and mood make decisions volatile. Symptoms feel urgent one week and trivial the next.

• Event-driven distortions: Salience and anchoring mean that one scare or one encounter defines behaviour, overshadowing ongoing patterns.

• Chronic distortions: Averaging, omission and interference conceal variability and gradual decline, delaying care.

• Social distortions: Satisficing, self-schema and desirability bias reshape memory to conserve effort or protect identity, often at the expense of timely help.

The result is that help-seeking is not a rational weighing of symptom histories, but a biased interpretation filtered through memory.

Implications for Healthcare and Intervention

These biases help explain common clinical observations: patients present late, underreport symptoms or oscillate between overuse and avoidance of services. To counteract this, interventions must work with, not against, memory.

• Shorter recall windows: Ask about symptoms in the past few days or week, reducing recency distortions.

• Symptom diaries or apps: Externalise memory so variability and gradual decline are visible, countering omission and averaging.

• Structured prompts: Use clear checklists and examples to reduce satisficing and interference.

• Neutral framing: Reduce stigma by normalising disclosure, counteracting social desirability.

• Repeated measures: Collect reports across different days and states to balance mood-congruence and recency.

Designing healthcare systems with these biases in mind makes help-seeking less vulnerable to distortion.

Conclusion

Help-seeking behaviours are shaped as much by memory as by symptoms. Working memory biases ensure that people act not on a neutral record of their experience but on a distorted version filtered through recency, salience, mood, omission and self-image.

• Recent and vivid episodes dominate.

• Routine, chronic symptoms vanish.

• Mood and state shift perceptions day by day.

• Identity and stigma reshape what is recalled.

The result is delayed care, premature reassurance or help-seeking triggered by extremes rather than steady need. Recognising these biases allows clinicians and system designers to create tools and contexts that compensate for memory’s limits, supporting timely, appropriate and equitable help-seeking.

Help-seeking is never just about symptoms. It is also about what can be remembered. And, as we have seen throughout the last articles, memory, inevitably, is biased.

Thank you for reading,

Mark Gibson

Clermont-Ferrand, France

September 2025