Terrighena EL, et al. – This research intends to demonstrate that visual stimulus awareness plays a crucial role in ­determining whether vicarious pain primarily activates behavioral defense systems that enhance pain sensitivity and stimulate withdrawal or appetitive systems that attenuate pain sensitivity and stimulate approach. The authors propose that while – strikingly – the appetitive system is activated in a highly automatic manner independent from stimulus awareness, the activation of defense mechanisms by vicarious pain depends on relatively elaborate cognitive processes. Such mechanisms may have developed to facilitate empathic, protective approach responses toward suffering individuals, ensuring the survival of the protective social group.