The cortisol awakening response (CAR): Facts and future directions
Abstract
In humans, the secretion of cortisol from the adrenal glands follows a diurnal cycle with a profound increase after awakening. This increase after awakening, a phenomenon termed the cortisol awakening response (CAR), appears to be a distinct feature of the hypothalamus-pituitary-adrenal (HPA) axis, superimposing the circadian rhythmicity of cortisol secretion. Several studies point towards an important role of the hippocampus and, additionally, other brain structures (e. g. amygdala, prefrontal cortex, suprachiasmatic nucleus) in the regulation of the CAR. There is increasing knowledge that the CAR is influenced by a variety of factors such as gender, health status, and health behavior or stress perception. However, the exact function of the profound cortisol increase after awakening is still not clarified. We hypothesize that the anticipation of the upcoming day is of major relevance for the magnitude of the CAR. The present paper reviews the current knowledge on the neural regulation of the CAR and factors influencing this phenomenon and considerations are addressed concerning the exact function of the CAR.
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The CAR serves to mobilize resources to meet the perceived demands of the upcoming day.
“current theory suggests that it serves to mobilize resources to meet the perceived demands of the upcoming day (e.g. Adam et al. 2006; Fries et al. 2009).”
From The cortisol awakening response predicts major depression: predictive stability over a 4-year follow-up and effect of depression history (2013) · cites this paper as Fries et al. 2009
Current theory posits that the CAR functions to prepare the individual to rise to the expected demands of the upcoming day.
“Current theory posits that the CAR functions to prepare the individual to rise to the expected demands of the upcoming day (Adam et al. 2006; Fries et al. 2009); thus, the presence of the CAR can be seen as adaptive.”
From The cortisol awakening response predicts major depression: predictive stability over a 4-year follow-up and effect of depression history (2013) · cites this paper as Fries et al. 2009
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Lai, J. C. L., Chong, A. M. L., Siu, O. T., Evans, P., Chan, C. L. W., & Ho, R. T. H. (2010) · Biological Psychology · doi:10.1016/j.biopsycho.2010.03.012 · Cited by 24 · see citing works
Specific reduction in the cortisol awakening response after socio-affective mental training
Engert, V., Hoehne, K., & Singer, T. (2023) · Mindfulness · doi:10.1007/s12671-023-02074-y · Cited by 17 · see citing works
Oberste, M., Großheinrich, N., Wunram, H.-L., Graf, J. L., Ziemendorff, A., Meinhardt, A., Fricke, O., Mahabir, E., & Bender, S. (2018) · Trials · doi:10.1186/s13063-018-2747-8 · Cited by 15 · see citing works
Cortisol awakening response and testosterone jointly affect adolescents' theory of mind
Wang, H., Zhang, S., Wu, S., Qin, S., & Liu, C. (2022) · Hormones and Behavior · doi:10.1016/j.yhbeh.2022.105258 · Cited by 7 · see citing works
- Authors
- Fries, E., Dettenborn, L., & Kirschbaum, C.
- Affiliations
- Technische Universität Dresden (DE)
- Corresponding author
- Kirschbaum, Clemens
- ORCID
- Kirschbaum, Clemens
- Venue
- International Journal of Psychophysiology
- Publisher
- Elsevier BV
- Published
- 2009-04
- Volume
- 72
- Issue
- 1
- Pages
- 67-73
- ISSN
- 0167-8760 (ISSN-L)
- OpenAlex
- W2067664488
- Cited by
- 1,188
- References
- 24
- Citations by year
- 2026: 50 · 2025: 43 · 2024: 42 · 2023: 65 · 2022: 64 · 2021: 84 · 2020: 92 · 2019: 63 · 2018: 70 · 2017: 77 · 2016: 96 · 2015: 85 · 2014: 93 · 2013: 76 · 2012: 57
- FWCI
- 19.74
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Psychophysiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Keywords
- cortisol awakening response, diurnal cortisol rhythm, hypothalamic-pituitary-adrenal axis, circadian rhythm, hippocampus, amygdala, prefrontal cortex, suprachiasmatic nucleus, perceived stress, anticipatory arousal, gender differences, health behavior
- MeSH terms
- Animals, Anti-Inflammatory Agents, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Pituitary-Adrenal System, Wakefulness
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