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involves additional mechanisms beyond the sharing of emotion and includes self-regulatory mechanisms to modulate the observer’s experience of negative arousal. Specifically, in order to understand the emotions and feelings of others in relation to oneself, second-order representations of the other must be consciously available and must not confuse the other with the self. The medial and ventromedial prefrontal cortices are known to play crucial roles in decoupling first-person and third-person information and maintaining representations of the other as distinct from the self (5).

The regulatory component of empathy, especially regulation of internal emotional states and processes, is particularly relevant to the modulation of vicarious emotion and the experience of empathy as well as sympathy. Empathy is unlikely to lead to helping behavior if the observer is incapacitated by strong empathically evoked emotions, which is why emotional regulation is an important component in empathy. Indeed, children high in effortful control show greater empathic concern, and the tendency to experience empathy and sympathy versus personal distress varies as a function of their ability to regulate their emotions more generally.

How We Perceive Other People in Pain

When witnessing another person experiencing pain, the scope of an observer’s reaction can range from concern for personal safety, including feelings of alarm, fear, and avoidance, to concern for the other person, including compassion, sympathy, and care-giving. The existence of the perception-action coupling mechanism apparent in emotional contagion also seems to

account for our ability to perceive and understand the pain of others. In the case of pain, individuals are predisposed to find distress of others aversive and learn to avoid actions associated with this distress. This is even the case in many mammalian species, including rodents. For instance, rats that had learned to press a lever to obtain food would stop doing so if their response was paired with the delivery of an electric shock to a visible neighboring rat (6).

Recently, a handful of functional neuroimaging studies performed with healthy human volunteers revealed that the same neural circuits implicated in processing the affective and motivational aspects of pain in oneself account for the perception of pain in others (7). In one study, participants in a magnetic resonance imaging (MRI) scanner either received a painful stimulus or, in other trials, observed a signal that their partner, who was present in the same room, would receive the same stimulus. First-hand experience of pain resulted in activation of the somatosensory cortex, which encodes the way we feel aspects of a noxious stimulus such as its bodily location and intensity. Furthermore, the anterior medial cingulate cortex (ACC), and the anterior insula were activated during both first-hand pain and the anticipated experience of pain in someone else. These regions are responsible for the affective and motivational processing of noxious stimuli such as those aspects of pain that pertain to desires, urges, or impulses to avoid or terminate a painful experience. A number of other neuroimaging studies of empathy for pain in adults as well as in children have demonstrated that the somatosensory cortex is not activated only during first-hand pain but is also activated with the perception of other

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