Encountering another's suffering can elicit both empathic distress and empathic care—the warm desire to affiliate. It remains unclear whether these two feelings can be accurately and differentially predicted from neural activity and to what extent their neural substrates can be distinguished. We developed fMRI markers predicting moment-by-moment intensity levels of care and distress intensity while participants (n = 66) listened to true biographies describing human suffering. Both markers’ predictions correlated strongly with self-report in out-of-sample participants (r = 0.59 and r = 0.63, p < 0.00001), and both markers predicted later trial-by-trial charitable donation amounts (p < 0.05). Empathic care was preferentially associated with nucleus accumbens and medial orbitofrontal cortex activity, whereas distress was preferentially associated with premotor and somatosensory cortical activity. In tests of marker specificity with an independent behavioral sample (n = 200), the empathic care marker was associated with a mixed-valence feeling state, whereas the empathic distress marker was specific to negative emotion. Ashar et al. present fMRI markers predicting the intensity of two different empathic emotions in response to naturalistic, dynamic stimuli. The markers predicted charitable donations, were supported by distinct large-scale brain systems, and were differentially related to eight other feelings.
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