Vietnam veteran Ray St. John remembers driving 200 miles for a hamburger.

Dogged by anxiety from post-traumatic stress syndrome, he left his Beloit home and pulled through one tavern parking lot after another, each time deciding there were too many cars, too many people. He meandered north of Milwaukee, and then south to Kenosha County, before his unattended hunger finally overcame his combat-induced fear of crowds, and he was able to eat.

That journey is just one illustration of the serious impact PTSD has had on St. John's life for four decades, including isolating him from others, harming his career as a retail manager and leading to broken marriages.

But now St. John, 62, is starting to overcome his combat-related anxieties thanks to a new therapy the Madison Veterans Hospital started offering last year that uses video game technology adapted to take veterans through three-dimensional renditions of their worst nightmares.

"When the machine gun went off I actually jumped," St. John said of the therapy. "When I came out of it, I was soaking wet with sweat. It's probably the hardest thing I've ever done, but it's created the best results I've had."

He's one of a handful of veterans who have tried the therapy at the hospital.

About one in five U.S. veterans of combat in Iraq and Afghanistan are believed to have PTSD symptoms -- sleeplessness, anxiety and hyper vigilance -- and only half seek help. Untreated, it can lead to drug use, suicide, marital problems and unemployment.

Madison hospital officials say they hope the new therapy will increase the effectiveness of treatment for PTSD.

New wrinkle

Use of virtual reality software is a new wrinkle in a proven technique called prolonged exposure therapy that relieves PTSD symptoms by helping veterans relive, and move beyond, terrible memories and emotions they have avoided.

The Madison Veterans Hospital has been offering prolonged exposure therapy for years, and about a year ago it bought the virtual reality equipment, said Lori Phelps, a Madison Veterans Hospital psychologist in its PTSD clinic.

The therapy is difficult, and not everyone who has tried it has stayed with it.

"To those who can withstand it, it's very positive," Phelps said.

The software was adapted from a video game called Full Spectrum Warrior. It has versions specific to Vietnam, and to Iraq.

To use it, the veteran sits or stands on a platform that vibrates in concert with explosions seen and heard through the head set, and uses a push-button console to control virtual movement on foot or in a vehicle. Motion sensors in the headset allow the participant to look around in a 360-degree environment. The therapist sets the scene to simulate the time of day, weather and environment.

As the veteran tells a story of combat, the therapist sits at a computer monitor and activates sights and sounds, including such things as gunfire, IED explosions and mortar attacks.

St. John said he and a therapist started working together eight months ago by discussing many times the specifics of an ambush he experienced in Vietnam.

After five weeks of talk, they started using the virtual reality equipment.

Machine gun fire

On Nov. 11, 1969, St. John was a sergeant leading one of several squads on a search- and-destroy mission in the triple-canopy jungle near Loc Nihn, about 60 miles north of Saigon.

As the squads advanced, St. John said, he could hear the whispering of enemy combatants in the distance. St. John's squad was preparing to set up its night defense position when machine gun fire crackled through the foliage from the direction of a forward unit, maybe 150 yards ahead.

"Then the fire opened up all along our whole flank," he said. "I remember being behind this log, and every time I lifted my head up, the machine gun would open up and just pepper this log."

Two men from other squads were killed. About half of St. John's squad was wounded. He was hit in the face and upper body by shrapnel.

"There were so many things you couldn't control," he said. "I know a lot of people blame themselves for other people dying. There's nothing you can do to change it."

By reliving the experience through the exposure therapy, St. John says he's starting to overcome his survivor guilt.

'Good treatments'

The Madison Veterans Hospital has 12 full and part time therapists in its PTSD clinic. About 400 veterans are referred for treatment each year.

"We have good treatments," said Tracey Smith, who manages the clinic. "Our big problem is getting people to come in for therapy."

Part of the problem is soldiers are afraid a PTSD diagnosis will harm their careers, according to a survey of military personnel. Another problem is the desire to avoid painful memories.

"When bad things happen, people say, Aw, just don't think about it. But when really awful things happen, you have to engage with it," said Phelps. Avoidance produces PTSD symptoms, she said.

St. John said he hopes that returning Iraq and Afghanistan veterans don't wait to get help.

"You always carry the deaths and the hurt and pain in you, but you realize that there's nothing you could have done," St. John said. "It's a matter of getting help, making life easier. Learning how to cope with what you have."

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