(Flickr/Topher McCulloch)

Chris Merkle rejoined civilian life five or six years ago but still sports the crew cut characteristic of a Marine.

“I feel like I can’t let it grow out. It’s part of who I am,” Merkle said.

With 10 years of military service under his belt, Merkle once considered going into law enforcement—but then the Twin Towers came down. After September 11, he went to Iraq and Afghanistan for another four years, as both a member of the military and a contractor for various security agencies.

Transitioning to life back in Orange County was hard. Merkle battled mood swings and avoidance issues. For a time, he refused to acknowledge them. During a particularly stressful experience, he finally decided to reach out to the VA.

“They tried to help me with some big group stuff and I did the individual psychotherapy which basically is talking one on one with a counselor. But it wasn’t really effective,” Merkle said. “It was an hour-long session but half of our hour was trying to build rapport, talking about superficial stuff. ‘How was your day? How was your week?’ I would talk about traffic but I couldn’t really get into what was deep down bothering me: my experiences in that war.”

His therapist had mentioned a virtual reality therapy clinical trial once or twice but didn’t press him about it.

“I was really resistant to it because nobody wants to relive their worst days,” said Merkle.

Still, in an effort to remain in therapy, he decided to give it a shot.

The World of ICT

The Department of Veterans Affairs believes Post-traumatic Stress Disorder, commonly known as PTSD, occurs in 11 to 20 percent of veterans of Operations Iraqi and Enduring Freedom.

The University of Southern California’s Institute for Creative Technologies, or ICT, is partially funded by the United States Army and has worked toward providing relief from post-traumatic stress through the creation of interactive immersive technology for almost a decade. The ICT's projects include stress resilience training, in a simulation similar to "Band of Brothers," using virtual humans as practice patients for therapists and an online virtual human health care guide called SimCoach.

One of ICT’s other systems is Bravemind, an application that takes its users to Afghan and Iraqi cities and deserts with the slipping on of headgear. There is a range of environments – including nighttime, low light and cloudy skies. A click of a mouse can make a jet fly overhead or a helicopter land while the pad users stand on quakes as a machine puffs out the smell of burning rubber and gunpowder into the air.

“We did a study … The first three sessions are basically to get to know the patient. And then move forward with the exposure in sessions four through ten,” said Albert Rizzo, ICT’s Medical Virtual Reality director. “Our sample was 20 active duty service members.”

That 2010 study found a noticeable improvement in PTSD symptoms for 16 of them, even months after it was completed. An April 2014 Emory University study also found that shorter doses of virtual reality reduces post-traumatic stress symptoms.

“So basically what we do is we have people, in a very systematic and planned out way, go through their trauma and learn how to tolerate it,” said Todd Adamson, the primary virtual reality therapist at the Long Beach VA. “Over time, it becomes less stressful. You essentially develop a different relationship with it – where it was controlling you and now you’re controlling it.”

Merkle remembers when soldiers from his own force had been injured and he recalls the pain and hurt he felt driving away in a Humvee that day.

With each session, it hurt a bit less.

“There were so many little breakthroughs. I would just take my headset off after a while,” Merkle said.  

Challenges and Triumphs

A recent Popular Science article posed, “Can You Get PTSD From A Virtual Experience?” Rizzo says that there’s always been that fear, even with traditional forms of exposure therapy. But the data in clinical trials with well-trained clinicians supports ICT’s work.

“We’re not doing anything science fiction here. We’re delivering an evidence-based treatment in a virtual environment,” Rizzo said.

A person wouldn’t be thrust into a situation they can’t handle and expected to stay there.

“In some ways, watching how exposure’s being done is like watching grass grow. The therapist may just set the context and maybe hit one button and blow something up in the distance and have the patient go through time and time again,” Rizzo said. “It’s not about playing Beethoven’s Fifth here. It’s more about chopsticks.”

And people have to want to get better and change, said Adamson. The form this therapy takes can play a role in maintaining the desire to do so for a generation that has grown up playing video games in an increasingly digital world.

“At this point, it’s another tool to help with the process. Some people will respond to it better than other people. Everybody’s different,” Adamson said, noting that bringing up memories can come more easily to others. Being able to see those images in their minds and talk about it is a way to help process an experience.

Merkle acknowledges that this form of therapy isn’t for everyone and that veterans have to want treatment and consider their decision carefully.

“You have to weigh, is it worth it? Is it going to make me a better person? Is it going to make me move forward in life? I think that’s the biggest thing,” Merkle asked. “Am I going to get past my experiences in the war ... and learn from it? Or am I going to let it fester and grow and create a dark place in my heart?”

He had his answer.

Now a psychology student at Vanguard University in Costa Mesa through the GI Bill, Merkle plans to earn a graduate degree in social work and work with his fellow veterans. He also leads the Orange County chapter of Team Red, White and Blue, a nonprofit that connects veterans to their community through physical and social interactions.

“I want to move forward. I want to help people. I want to help myself first so I can help other people.”

Reach Staff Reporter Maritza Moulite here and follow her on Twitter here.