Héctor Lozano speaks in Gibraltar about the psychology of the first step in mental health

Today, in Gibraltar, Héctor Lozano Jiménez, General Health Psychologist and director of Ocnos Psychology Clinic, took part in a talk organised by The Gibraltar Mental Welfare Society, introduced by Mark Montovio, as part of Mental Health Awareness Week.

The session was titled The Psychology of the First Step: From Worry to Action. Its central question was simple, but deeply human: if someone already senses that something is not right, why can taking the first step in mental health feel so hard?

The talk was not about motivational slogans or quick fixes. It explored a very common psychological experience: knowing something needs attention, and yet staying still. Thinking about it. Postponing it. Waiting to feel ready. Telling ourselves that perhaps it is not serious enough yet.

A talk in Gibraltar about mental health and action

Mental Health Awareness Week helps bring mental health into public conversation. But conversation alone is not always enough. This year’s key theme was action.

That idea became the starting point of the talk. What does taking action mean when we speak about mental health? Does it always mean starting therapy? Does it mean sharing everything at once? Or can it begin with something smaller, more human and more possible?

In his talk, Héctor explained that many people do not reach therapy because they “do not know” something is wrong. Quite often, they do know. They have felt it for a long time. They have thought about it many times. They may even have imagined possible solutions.

But between knowing and starting, there can be a very wide gap.

Knowing something is wrong does not always mean acting

One of the first ideas in the talk was simple, but very recognisable: awareness is not the same as action.

We may know we need rest, but keep pushing. We may know that a relationship is hurting us, but avoid speaking about it. We may know that anxiety is shaping our daily life, but wait until we feel “better” before asking for help.

In therapy, we often hear sentences such as:

• “I know I should do something, but not now.”
• “When things calm down, I’ll sort it out.”
• “Maybe it’s not serious enough.”
• “I should be able to deal with this on my own.”

The difficulty is that these sentences sound reasonable. They do not always feel like excuses. Sometimes they even sound careful or responsible. However, when they repeat themselves for weeks, months or years, they can quietly keep the problem in place.

Worry is not always progress

During the talk, Héctor used a clear metaphor: worry can be like a rocking chair. It gives us something to do. It keeps us moving. It can even make us feel responsible. But it does not necessarily take us anywhere.

This happens often in anxiety. Thinking a lot can feel like preparation. Analysing every possible outcome can feel like caution. Searching for more and more information can feel like responsibility.

However, when thinking becomes a substitute for action, we are no longer preparing. We are avoiding.

Fear, shame and uncertainty: what blocks the first step

Taking the first step is difficult because it is not only a practical action. It is also an emotional experience.

Asking for help can make a person feel exposed. Speaking about what is happening can activate shame. Changing a routine can bring discomfort. Making a decision without knowing what will happen next can open the door to uncertainty.

That is why it is not helpful to judge someone who feels stuck as if they simply “do not want to get better”. Often, they do want to. The issue is that moving also means tolerating some discomfort.

Clinically, this is especially relevant in difficulties such as anxiety, low mood, obsessive patterns and prolonged avoidance. The aim is not simply to “think better”, but to recover, step by step, the capacity to act.

Avoidance gives relief now, but can narrow life later

Avoidance is powerful because it works in the short term. If something makes me uncomfortable and I avoid it, I feel relief. If I fear a conversation and postpone it, I can breathe for a while. If booking an appointment makes me anxious and I close the page, my anxiety drops.

The problem is the long-term cost.

Each time we avoid something important, the problem does not usually disappear: it waits. In addition, our confidence may become smaller. Without realising it, we send ourselves an internal message: “this is too much for me”.

That is why one of the aims of therapy is not always to “remove fear” before acting. Very often, the work is learning to act in small and safe ways while fear is still present.

The first step does not have to be big

Another central idea from the talk was that the first step does not need to be impressive. It does not need to look like a dramatic life transformation. It does not need to solve everything in one day.

In fact, the bigger we imagine the change, the more likely resistance is to appear.

A first step could be:

• writing down, in one sentence, what is happening;
• sending one message to someone you trust;
• asking for information about therapy;
• going for a five-minute walk;
• setting one small boundary;
• returning to one simple routine;
• saying honestly, “I am finding this difficult”.

None of these steps are dramatic. But they are real. And psychologically, what is real matters much more than what is perfect.

Confidence often appears after action

Many people wait to feel ready before they begin. They wait to feel certain, calm, motivated or confident.

But in mental health, that wait can become a trap. Confidence does not always appear before movement. Often, it appears afterwards.

When a person takes a small step and discovers that they can tolerate it, even imperfectly, the brain learns something new: “perhaps I can cope with slightly more than I thought”.

This is how personal agency begins to rebuild itself. Not through grand speeches, but through small repeated experiences.

From “what if?” to “what now?”

Worry often lives in imagined futures: “what if it goes wrong?”, “what if they judge me?”, “what if I cannot cope?”. A small step brings attention back to the present: “what can I do now?”.

That shift may seem simple, but psychologically it is powerful. It moves us from being spectators of our own lives to participants.

Taking the first step does not always mean starting therapy

An important part of the talk was clarifying that looking after mental health does not always begin with a clinical appointment. Therapy can be a very valuable path, but it is not the only way to start.

For some people, the first step will be speaking to a friend. For others, it will be recognising that they have been avoiding something for months. For others, writing down what they feel. For others, booking an appointment with a psychologist.

What matters is that the step is honest, concrete and viable.

In therapy, we often do not begin with huge changes. We begin with basic questions: what is happening, what is being avoided, what is keeping the problem going, and what small movement could make sense now.

From Gibraltar to Palmones: continuing the conversation about mental health

For Ocnos Psychology Clinic, taking part in a talk like this in Gibraltar has special meaning. Our clinic is located in Palmones, in Campo de Gibraltar, close to Gibraltar, Algeciras, La Línea de la Concepción, Sotogrande and San Roque.

We provide psychological therapy in Spanish and English, both in person and through online therapy. Above all, we try to make the therapeutic process human, practical and respectful of each person’s pace.

Mental health does not improve through campaigns alone, nor through information alone. It also improves when a community makes it easier to speak without shame, ask for help earlier and stop treating psychological distress as something that must be hidden.

That was, at its core, the message of the talk: you do not need to see the whole path clearly before you start. Sometimes, one step is enough.

Slides from the talk: The Psychology of the First Step

Below you can view the presentation used during the talk. Click on the main image to open it in full size and move through the 20 slides.

Tip: on mobile, tap the main slide or any thumbnail to view it larger. You can then move forwards or backwards using the arrows.

View full presentation

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20