Avoiding a Panic Attack... Until You Can't Anymore
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- Опубликовано: 4 мар 2023
- #thelastofus #drelliott drelliott #doctorreacts #psychiatrist #mentalhealth
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Let's carry on with the Doctor Reacts videos to The Last of Us. This is on episode 6, and I discuss panic attacks, PTSD, alcohol's effect on the body, cognitive behavioural therapy and much more. This show is so forthcoming with addressing trauma and mental health difficulties.
Let me know what you think!
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Comparing how they are both survivors and both full of pain and trauma, Joel sadly has more in common with Ellie than with his own daughter - it's one of the many tragic themes in The Last Of Us.
And, eventually, Ellie picks up more and more of Joel along the way. For better or worse. Mostly worse. Much worse.
"That thing that's pokin' in there, that shouldn't really be there. Insides should stay inside."
Thank you, this is the in-depth medical content that keeps me coming back every week. :)
Before I made it into proper therapy for it, I used clocks to get myself out of a panic attack cycle once I recognized what was happening. The attacks themselves were really rough experiences. My heart would start racing, I wouldn't be able to breath, sometimes hyperventilate trying to force myself to breath, and even collapsed a few times from the struggle. Thinking about time helped though. I convinced myself that no matter how bad things felt it would pass and I'd be fine the next day. Then I could use that knowledge as a sort of mental life raft and just check the time and calculate in my head things like "Oh, in four hours it will be morning and this will be over." Those sorts of simple thoughts worked well. At a certain point, things got tot a point when I couldn't do it all on my own and found someone to talk to. It took a year or so of medication combined with regular cognitive behavioral therapy to get to the root cause of why I started getting panic attacks in the first place and push past it. These days I don't have any medication or regular therapy and the panic attacks are gone.
That’s really practical advice
I work in a restaurant, and I've found that going into the walk-in freezer for a few minutes is a very effective way to shock myself back into my body if I'm starting to panic or disassociate. Also, welcoming the bad feelings, accepting that they're there (as opposed to panicking about the panic on top of whatever I'm already panicking about), and reminding myself that in a few minutes, I'm going to feel a lot better.
There’s a therapy that involves putting you face in a bowl of ice water, or at least putting ice on your upper face. It tricks your body into coping with the climate conditions instead of fueling the crisis. If you have a walk in freezer that’s excellent.
I don't have panic attacks but I do appreciate your efforts to get feedback from your viewers.
Me too
Maria didn't say not to trust others, but to be vigilant when considering who you put your trust in.
It's apt advice in a world where most people who held on to their morality are dead, and the ones who survived are the ones who let go of their morality. And Joel is a man with very few moral lines left to cross.
I used to get a lot of panic attacks daily and I always found the suggestion to look at objects or count corners ridiculous. What really worked for me the most was to turn on something to watch or something to read and I'll slowly calm down as I focus on what I'm watching/reading instead. But most of the time I would just end up going to a bathroom and going on my phone until I calmed down as it usually was in public spaces.
My symptoms would start with rapid heartbeat, cold sweats, shaky hands, and then I would get very sick and often have to throw up.
I had a period where I smoked weed every day and it did help me but looking back it didn't help me sort out the issues, only the symptoms. So in the end it only made the issue worse once I stopped smoking. Don't want to be reliant on a vice just to feel good.
These days I get anxiety sometimes (On antidepressants) but luckily no more panic attacks, wouldn't wish it on my biggest enemy. I'm so thankful I don't get them anymore.
No clue with insomnia though, It takes me like 4+ hours to fall asleep every day which sucks...
When I was processing my first divorce I started getting panic attacks at work because they were minimal no thought factory work and I would have to distract myself by asking a coworker I work with their life story pretty much 😂 he was an old man and I learned a lot from him listening about his life up to that and a mutual respect.
When I couldn’t avoid it I’d kept caught up as I could and just put my head down with my hands on my head (also covering my ears) take deep breaths to slow my breathing and clear my mind of everything and where I was. When my chest lightened up and I had a better control I’d catch up on my work
I always know I’m about to have a panic attack when I get that sudden feeling of dread 😭 slow, deep breathing helps but honestly the best thing I’ve found is to distract myself from the thing triggering me. Doodling, scrolling on my phone, talking to someone about a light topic. Biggest piece of advice is just to get out of you own head in any way you can bc otherwise you’ll spiral
I manage panic attacks by taking deep breaths, feeling my pulse (I often have an irrational fear my heart stopped), and tell myself it’s okay and I’m okay.
I (fortunately) don't have traditional panic attacks, but I can really empathize with Joel here. Years ago I fainted twice seeing someone injure themselves (quite seriously) - seeing blood is not the issue, but I can't help empathizing, feeling sympathic pain and getting queasy. (Annoying as hell)
Ever since then, whenever I see or hear about someone getting/being injured I'm basically panicking out of fear to faint - which then threatens to make me faint. It's really hard to escape that vicious circle once you're in it.
The thing that really hits hard regarding Joel is that it's not just Sarah that he feels like a failure for. That trauma has snowballed over the years. He's a man who lets very few people in, but the people he has let in, he feels this need to protect them. In his mind, he failed Sarah, he failed Tess, he got to Bill and Frank's too late, he failed to hear Henry and Sam sneak up on them, he failed to protect them, and he failed to protect Ellie from them, and the entire time he was desperate to find Tommy, not knowing if he might have failed to find and protect his brother in time. It's why the panic attacks start with that woman telling him "If your brother is across that river, he's gone". It's so heartbreaking, because realistically nobody can handle that kind of pressure and almost all of those things were entirely out of his control.
I tend to spiral in a similar way, and my panic attacks used to feel like they came out of nowhere. I can't always tackle them before they get bad but basic grounding exercises alone can help a lot. Focusing on breathing in the noise/out the mouth, looking at my surroundings and counting things, naming things, ect, helps to shift my attention away from whatever is freaking me out. It's dissociation I still really struggle with, once I'm out, bringing myself back to earth feels impossible 😩
Spiral is the exact word I use to warn my husband I am anxious and may have a panic attack. Because that's exactly what triggers it, a thought that spirals out of control into many other negative thoughts all at once.
I’ve only had a few but when they happened I tried to listen to a meditation/sleep video and breath through it. Once it had passed I tried to understand why I had one. Understanding why it happened usually helped me.
7:21 I think it’s more that she is saying “be careful who you trust” because they are the only ones who can betray you, rather than don’t trust anyone.
I get anxiety from driving after a bad auto accident. I try to head it off before it gets bad, telling myself everything will be fine, I got this, breathing through frightening situations, focus on the road ahead of me trying to zone past big trucks and barriers at my side, focus on music playing, and trying to stay away from situations I know set me off. Sometimes it isn't enough, and the more stuff happens on the road the more my heart rate goes up, the more likely I'll have a full blown attack. If it's getting too hard to control I'll get off the road, try to find a restaurant or someplace I can sit down and wait to get it under control. Most of the time I am off the road before I have an attack, but there have been a couple times, like in storms on a freeway where there's no exit for a long time. They don't like people pulling off on the shoulder here, but if I can't find an exit I will pull off. I try breathing slowly in and out maybe a 5 count each breath, or slow breathing counting back slowly from 10.
I always look forward to your reactions to these episodes! It’s so interesting to hear a professional take on the psychology behind the characters 😄
One strategy that works for me is distracting my brain by playing a game on my phone like snood, tetris, or solitaire. There's just something meditative and soothing about simple puzzle games that revolve around matching stuff up.
I loveeee that I watch the episode and then I rewatch it with you! And learn so much!! ❤
Doctor, you do a very good job of explaining all this so I can understand, Thank you.
What helps me, when I have a panic attack, is reminding myself, that my body can't keep this level of stress up for a long time and it will soon pass. "The more intense the feeling, the faster it passes" has become kind of a mantra, even though it's simplyfied. I tell this to myself and take a breath with every repitition of the thought.
In therapy I learned about having a safe space in your mind where you can go to to calm down when you're feeling you're having a panic attack. Like a memory or a place that makes you feel calm and comfortable and try to think about that to calm down. Also assessing the situation by analyzing what's happening. Asking yourself the questions. Where am I? Who are the people around me? What's going on? When is this happening? and why is it happening?
Quite a few therapists and a couple of medical doctors are commenting on this series. Yours however is better than most. I was a counselor for many years and a cognitive behavioral approach usually worked when dealing with the effects of physical violence and PTSD.
Note - Your title for this episode says 5 again instead of 6 BTW
Excited to see your reaction to the next episode!
If you haven't seen it before, an interesting series to take a look at might be Mr. Robot. Without getting too spoilery, psychology and the mental health of the protagonist play a big part in that series, and it has an abundance of LGBT characters and themes.
It also just happens to be a fantastic series that deserves more love.
I agree on that. Crazy series it would be very interesting to see how dr elliot analysis it
To suppress a panic attack or to regain control as quickly as possible, you have to be very self-aware and you have to train yourself to subvert your own expectations. What are your triggers? Set off by loud noises? Simply covering your ears probably won’t help, but covering your ears with your palms and lightly tapping your head with your fingers creates a disruptive rhythm in your head that makes the noise around you less overwhelming (also helpful if you have tinnitus). Having flashbacks to a traumatic moment in your life? Interact with something that wasn’t present-focusing on the texture of tree bark or grass may help if your trauma occurred indoors, a lush tropical perfume might calm you if you’re fighting off memories of a horrible winter, etc. Triggered by opposing things? I can have panic attacks if I feel trapped and if I feel too exposed, but shutting myself inside a dark space helps in both cases. Why? Because I can’t see a thing, and a visual cue set off the alarm. Physical contact with others can put me on edge, but when I’m having nightmares or flashbacks, physical contact with someone I trust can keep me from flinching away from everyone around me, because you don’t decide it’s cuddle time when someone is about to hit you. “Hey, Panic Brain, what happens when an unstoppable force meets an immovable object?” Give your brain a puzzle it can’t solve.
I used to get panic attack, at the most random times. Usually get ringing ears, light headed, spinning feeling. I would try to find a place to sit and breath. As I've gotten older I think I'm still anxious but not about other people. I don't know how to tell people how to stop caring about people around you, maybe just aging, because being in crowds used to trigger me.
I'm getting PA's usually when I'm already mid-breakdown, so they are quite easy to catch. I just need to completely block everything off - close my eyes and ears and not let people touch me, and in few seconds I can steady my breath and get focused back (which also stops the breakdown). So it's a flight for me, but thankfully they start when I'm getting too overwhelmed and not when there's a physical danger.
Insides should stay inside but if you get stabbed leave the pokey thing in, don't pull it out!. It slows bleeding and, depending what it's poking, pulling it out could cause more damage (though I guess in an apocalypse with no doctors you'd have to remove it yourself eventually)
Panic attack prevention answer: I can usually tell when panic is starting to build because my chest feels tight, which I'll notice because I suddenly realise that I'm self-soothing by rubbing my hand over my sternum. Once I notice that, I become more aware of what thoughts are driving that feeling and can start to counter them and do things more consciously to calm myself down. But it took me a long time (and a period of regular, acute panic attacks) to realise I had that warning sign.
My way dealing with Panic Attacks
To help me prevent one I notice my breathing, if too fast I try to slow it down by slowly breathing, feeling & focusing on air going into my lungs then releasing. I also watch a RUclips video called leafs on a river. It's a meditation vid.
What I do if panic attack happens. I try to ground myself. I look at things and describe by object and color like table brown or white wall, green and blue cup etc. I keep describing so I don't focus on my thoughts that brought on the attack. I keep going until I can notice my breathing and slowly in and out while describing.
I do recommend practicing the exercises when ur not in a panic attack cuz its harder to remember the exercises during an attack. Practice when not in panic mode that way ur brain can try to remember the exercises better. I've taught my friends these and it's help them immensely.
I think generally that 'keeping the things inside that are supposed to be there', maybe with the added 'the things outside are supposed to stay outside' are pretty solid advice.
A trick I found online that has helped me when I'm strong in a panic attack is to count backwards from 100 picturing each number as a different color. Not exactly sure how it works, but it seems to take so much mental energy it cuts off the power supply to the panic attack which fizzles off. Everyone I've shared it with has had the same benefits. Not foolproof but high success rate.
When I have a panic attack within the past year it’s triggered by certain kinds of interactions at work, that challenge reality for me. Unfortunately just because I start having a panic attack doesn’t mean these interactions stop, though I suppose I could just say I’m having a panic attack leave me alone. But the desire to not be vulnerable is super strong in those moments. I know the difficulty breathing and the rapid pulse and the lightheadedness will pass, and am more concerned with the fact that I start crying. Like, “Well this interaction is irrational, wait I’m starting to cry”. So I go where I can’t be seen and deep breathe and whatever, and when I think I can not cry for a few minutes try to resolve the situation and hide again so I can calm down. I guess my tips are deep breathing, focusing on something else like repetitive work.. and tell people you’re having a panic attack so you can properly cope which I haven’t tried yet, lol.
Regarding panic attacks: If I’m able to (meaning not in public) I lie on some hard bit of ground like a hard floor or pavement because the pressure discomfort spread out around my body seems to distract my nervous system.
Just yesterday I was near a full blown panic attack. I know my trigger is specific sounds so when I felt my heartbeat and breathing accelerating and the ringing in my ears increasing I payed attention to my surroundings and realized the sound so fortunately, I was able to ask for the noise to stop and although it took me a couple of minutes, I eventually calmed down.
I have been getting panic attacks since I was 10 years old (now 23) I tried many things but sadly the usuall recommendations make me panic more (Breathing , tapping, focusing /counting objects) . If I feel a panic attack coming I go to an isolated area and lay on the floor or find a small confined space, (like under a table or inside a closet). Nothing else helped, until one time in one of my worst panic attacks I ever had, I couldn't leave the area. My panic attacks were always super dramaric, this time I was screaming and flailing and sobbing in a public space. But then some girl approached me and talked to me, and she held my hand and told me to squeeze it as hard as I can. That and her talking to me, asking me questions, helped it subside.
Title says Episode 5 instead of Episode 6.
Breathing is the absolute key in my experience! With panick attacks peoples heart rates spike and they tend to start hyperventilating. Slow, deep, rhythmic breaths help a lot.
For panic attacks and just feeling overwhelmed in general I’ve found grounding very useful. Name 5 things you can feel, 5 things you can hear, 5 things you can see and something you can taste. Just rolling through a couple of these can deescalate a spiralling mind.
It’s good to run through these with eyes closed and do the seeing one last :-)
I soon realised I dissociated if I was going to have a panic attack. I therefore try to get somewhere I feel safe. Grounding and mindfulness help also calling my sister to calm me down. the anxiety can take a few days to turn into a panic attack/BPD episode now I attempt to use adaptive coping skills.
My usual way of dealing with a panic attack is to play songpop. It's a game where you hear a song and you have to guess the title or the artist. It gives me something to focus on, something to do, something to take my mind off it and music is useful in general.
Almost ten years ago I had surgery on my hand (which was not a good experience) and several months later I started having a lot of pain in that same hand for no reason that they could find. So I played a lot to deal with my panic attacks back then, influenced a lot of the music I still listen to today. After a while things got better and the game wasn't as much fun without them so I stopped for years but every time I got a new phone I always downloaded the app to make sure I was prepared. And then I had surgery on the same wrist three months ago. Apparently it still works, so that's something
I know this sounds cliche’, but journaling before bed has helped along with getting on the right medication. Otherwise, I will sit and ruminate over what happened that day or even in the past.
This is TMI but my anxiety presents itself as me feeling like I'm going to shit myself and then that feeling makes it escalate because I don't want to do that lol
It's gotten to the point where I don't leave my house often. Medication is helping, though, thankfully.
I miss my life in 2019 before the pandemic. I never had anxiety like this before then.
“Insides should stay on your insides.” Life saving advice here!
I know I'm getting a panic attack when I feel 'off' and my breathing feels like I can't really control it, usually I just put on an episode of a show or something to distract me while I calm down and then do the deep breathing things
For my panic attacks, I sing a song to myself that I associate with my honeymoon. It takes me back there with my husband as newlyweds. Before that, I used to visualize my cat sleeping under a tree in our backyard on a warm day. Both are happy and calm memories for me that take me out of the panic moment
First, identify signs that you’re panicking, physical symptoms such as tense muscles, rapid breathing and sweating. Try to slow yourself down by slower belly breathing, remind yourself that you are safe, tap/ stroke yourself on the upper arms or chest, try the 5 senses method (5 things you can see, 4 things you can hear, 3 things you can feel, 2 things you can smell, 1 thing you can taste). Try not to fear that you’re in physical danger, sit down, give yourself time, be kind to yourself after.
Two ways I was able to assist others who were having a panic attack before:
1. I made sure that the environment was physically safe and signaled that to them (f.ex. by sitting on the floor with them in a comfy distance and relaxed pose) and
2. if there was a history of prior panic attacks, I reminded them they'd been there before and knew how it felt, basically suggesting that they had experience with the situation to strengthen their remaining sense of control.
Your situation will vary, excercise discretion - what helps one may not help another.
It depends on how big the panic attack is, for the small ones I just breathe it out or try the grounding technique, for the bigger ones I use the grounding technique or I need physical help from someone to help me overcome it.
I've had panick attacks I just couldn't stop and thought I was going to die, when they happened I needed someone else to pull me out of it.
For me, dealing with a panic attack starts well before you have one. Working to understand and allow my feelings to be has been very important. It's ok to feel sad, or angry, or overwhelmed, and if I continue with that line of thinking always, when I do have a panic attack it is less severe and more manageable. Everyone is different, I prefer to have my attacks (if I have the option) in a safe space like my bedroom, with the lights off, tell myself it's ok to feel this way, I'm only human
When I think I'm about to have a panic attack I first try to take deep slow breaths.
Then I try and slow down my brain or distract it, usually by trying to name 5 red objects in the room.
Hope that helps 😊
I struggled with panic attacks for a number of years after a traumatic experience. Thankfully a therapist taught me an exercise that actually worked: First off, sit or lie down. Focus on calming your breathing throughout the exercise. Keep in mind that you cannot have a panic attack if you a) breathe calmly and b) get your pulse down to a resting level. Then do the following steps described below. If you need to, repeat the steps 1-3 until the panic attack has passed and you feel OK: 1) Make a mental note of three things you see around you. Eg. "I see an orange on the counter top. I see my left hand resting on the couch. I see the sky through the window." 2) Make a mental note of three sounds you can hear. Eg. "I can hear a bird chirping outside. I can hear the crinkling of the fabric the pillow makes against my head. I can hear my own breathing as it slows and becomes calmer." 3) Make a mental note of three physical sensations. Eg. "I feel my head resting on the pillow. I feel the rough fabric of my jeans against my thighs. I feel my breath calm and slow down as it goes in [inhale] and out [exhale]." The sensation of your breathing will always be the third and final physical sensation you pay attention to. If you prefer, instead of making mental notes you can say everything out loud.
This exercise helped so much, and the familiarity of doing it hundreds of times over several years made it even more effective over time.
Recognising my attacks:
- it always starts at my stomach. It feels like a punch on the stomach or a knot at my throat.
- I get very confused, as in "I need to do something but can't remember. I need to go but I don't know to where or why"
During the attack:
- counting out loud until the panick is over. I even challenge myself counting in other languages to distract me more and calm down. I got once until the 300's
-While counting, slow breathing
For example: one *inhale* two *exhale* three *inhale*
- thanks to therapy, the attacks are significant shorter and less intensive thanks to the positive mindset "This will end. It came up and will go down. I know what is going on. I know what to do. I will survive. This will end."
The attacks itself were horrible, honestly. Couldn't stop crying, lost control over my body, heart pounding, a constant ringing in my ears... Once it ended, I get so fatigued I needed a whole day and night to recover
I've had panic attacks since I was 8 and at the time my therapist would press me for triggers and I'd tell her I have them for no reason and she wouldn't believe me. She'd say, "You can't have panic attacks for no reason!" She made me feel so small and wrong.
TIPS: Mantras help me SO much. Just repeating to myself that I'm safe is a huge help. Spotting different colors, touching things, engaging my senses (I dissociate with anxiety). I also sometimes picture my panic as a physical pain, like a pebble in my shoe so it's more of a "real" thing that I can treat as an inconvenience.
Breathing exercises DO NOT help me, just make me feel like I'm breathing wrong. And then I'll have a panic attack over asphyxiating somehow, ugh.
i always have a hard time trynig to figure out wheter its a panic attack or an anxiety attack and its usually jsut this growing sense of Doom, sometimes it starts of feeling very similair to one of my usual mild athma attacks, so it can be confusing whats what, but focusing on my breathing does help usually, its like.... exstinguishing the fire so the fire alarm stops blaring. (to bad the alarm broke so now its going of non stop, but thats why i got meds now)
I recently started having dejavu type panic attacks. Therefore I immidiately jumped on the comments to see if anyone had a good advice for it but I suppose we all have different things that helps. For me, I can't even move or speak from the intensity and sometimes the hyperventilating and my heart racing rapidly makes me almost lose my conciousness / black out. I get these almost 10 times a day and it can be a nightmare. If anyone is willing to share tips, please do! And hopefully it would help others' as well
My panic attack tips:
Find somewhere quiet if you can. If not, remove yourself from the situation as much as you can.
Concentrate on your breathing. Breathe in for 5 seconds, hold for 1, breathe out for 7, hold for one. Actually count. This does 2 things. It regulates your breathe to stop you from hyper/hypoventilating and it gives your mind something to do other than focus on the aggravating stimuli.
Reassure yourself. Things may not be fine, but you have everything you need to survive.
Talk about it afterwards. If you aren’t talking through the issues, you are treating the symptoms and not the cause.
Hope it helps
You've got 5 instead of 6 in the title.
Whenever I feel a panic attack coming I try to breathe through it and calm myslef down. It really helps that I know it's a panic attack and that I'm not actually dying. And for dealing with being in the middle of a panic attack well... I can't really take credit for this, since it was my ex boyfriend who did it. He saw me struggling to breathe and his mind just went "oh, mouth-to-mouth" and he just like... blew air into my mouth? 😅 What can I say? It worked, partly because forcing the air into my lungs kind of bypassed my brain telling me I couldn't breathe. And honestly I was just taken aback by him doing it that I got distracted. I have done it to some of my friends as well (with consent of course) or just have them use an inhalor and it's worked for them as well.
Can a panic attack last 20 seconds or so? I sometimes get short bursts where a negative triggering thought causes my heart to race and I involuntarily cry out and then take a deep breath and it goes away as fast as it comes. But these are happening 2 or 3 times a day everyday. Does not seem to be what others are describing as panic attacks.
booze is not good for coziness, but is good for sleeping 👍
Fight flight freeze or fawn (there are probably other f’s idk about)
I hum out loud
Close my eyes
And rock back and forth
I hope this makes sense 💔🥺
Sorry 😞🙇♀️
So what I've learned: blood belongs inside of people and not on the floor and getting stab is bad. Inside belongs inside. Thanks 😉
I personally have no experience with panic attacks so I have nothing useful to add to the conversation
Hmm... Is this episode 6, not episode 5?
Wait so - if cold weather causes vasoconstriction, does that mean it keeps your vital organs warmer at the expense of your arms and legs? In which case, alcohol would increase the risk hypothermia, BUT it would feel much cozier 😂 right?
❤❤❤❤❤❤
The title on this video is wrong. This is episode 6, but the title says it's 5.
woops. title still says episode 5. you should fix that.
Hey can you REACT to Music "Ren - Hi Ren" Please :)
He still hasn’t fixed the title?
Knifes should be outside of the abdomen ✅
You're a horrible medical doctor at best if you do not believe someone can die from a panic attack. 190/130 MAY happen from a panic attack and that MAY put the heart into arrest. You're wrong.
i hate fake doctors vs real doctors
I have PTSD and, while I'd have the unexpected panic attacks too, for a long time I would have very consistent ones trying to drive... or else I'd end up dissociating and sort of stalling them out? But of course, that's not exactly ideal for driving either. When I started therapy my therapist taught me the classic "senses" grounding technique to bring myself back to the moment. That was focused more on the dissociation, but I have used it to help calm down & steady my breathing to come down from panic attacks.
Usually l start to sweat and it feels like my heart's about to jump out of my chest. Heaving & irregular breath while l can't maintain a thought, it's just a fucking tornado. l sit down, focusing on my posture (grounding) while trying to take normal breaths with the Diaphragm, rather than with the shoulders (with eyes either closed or fixed on an object).
Also when "just" anxiety hits, l find doing aerobic uphill sprinting intervals or swimming (butterfly strokes) working the best. lt's like the anxious energy just sips out of you.
Haven't had one in a good while, but l imagine how Hollyhock in BJHM was taught would probably work as well (naming objects in the room out loud).