The awakening cortisol response: methodological issues and significance
Abstract
The awakening cortisol response (ACR) is a discrete and distinctive part of the cortisol circadian cycle. In healthy adults salivary free cortisol concentrations increase by between 50 and 160% in the first 30 min immediately post-awakening (approximate average increase of 9 nmol/l, range 4-15 nmol/l, estimated to be equivalent to about three secretory episodes). However there are no agreed norms for the absolute concentrations of free cortisol in saliva either immediately post-awakening (range of 4.7-18.5 nmol/l) or 30 min post-awakening (range of 8.6-21.9 nmol/l). This review explores reasons for these discrepancies in normative data including confounding factors such as gender, age, awakening time, light and participant adherence. Although the physiological role of the ACR has not been clearly defined evidence is discussed that suggests it is under a distinct regulatory influence, different from the rest of the diurnal cortisol secretory cycle. Despite the difficulties associated with its measurement a range of studies have demonstrated an association between the ACR and psychosocial variables, stress and health. However it remains unclear whether positive affect and good health are consistently associated with larger or smaller awakening responses. It is early days in the search for the role and significance of the ACR. Its putative role in the regulation of physiological function across the day (e.g. the immune system) and its sensitivity to psychosocial variables make it a prime candidate as an intermediary linking mind and health.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
CAR increases are large (on average 50-60% above waking levels) and highly variable across individuals.
“CAR increases are large (on average 50-60% above waking levels) and highly variable across individuals; as a result, individual differences in the size of this indicator can be easily detected and modeled statistically, and are of a magnitude that is likely to be physiologically meaningful (Adam et al., 2006; Clow et al., 2004).”
From Prospective prediction of major depressive disorder from cortisol awakening responses in adolescence (2010) · cites this paper as Clow et al., 2004
Cites
Pruessner, J. C., Kirschbaum, C., Meinlschmid, G., & Hellhammer, D. H. (2003) · Psychoneuroendocrinology · doi:10.1016/s0306-4530(02)00108-7 · Cited by 3,638 · see citing works
Salivary Cortisol in Psychobiological Research: An Overview
Kirschbaum, C., & Hellhammer, D. H. (2008) · Neuropsychobiology · doi:10.1159/000118611 · Cited by 1,532 · see citing works
Pruessner, J. C., Wolf, O. T., Hellhammer, D. H., Buske-Kirschbaum, A., von Auer, K., Jobst, S., Kaspers, F., & Kirschbaum, C. (1997) · Life Sciences · doi:10.1016/s0024-3205(97)01008-4 · Cited by 1,450 · see citing works
Diurnal Cortisol Rhythm as a Predictor of Breast Cancer Survival
Sephton, S. E. (2000) · Journal of the National Cancer Institute · doi:10.1093/jnci/92.12.994 · Cited by 1,082 · see citing works
Burnout, Perceived Stress, and Cortisol Responses to Awakening
Pruessner, J. C., Hellhammer, D. H., & Kirschbaum, C. (1999) · Psychosomatic Medicine · doi:10.1097/00006842-199903000-00012 · Cited by 822 · see citing works
The cortisol awakening response - normal values and confounds.
Wüst, S., Wolf, J. M., Hellhammer, D. H., Federenko, I. S., Schommer, N. C., & Kirschbaum, C. (2000) · PubMed · Cited by 700 · see citing works
Yehuda, R., Teicher, M. H., Trestman, R. L., Levengood, R. A., & Siever, L. J. (1996) · Biological Psychiatry · doi:10.1016/0006-3223(95)00451-3 · Cited by 653 · see citing works
Genetic factors, perceived chronic stress, and the free cortisol response to awakening
Wüst, S., Federenko, I. S., Hellhammer, D. H., & Kirschbaum, C. (2000) · Psychoneuroendocrinology · doi:10.1016/s0306-4530(00)00021-4 · Cited by 642 · see citing works
Steptoe, A., Owen, N., Kunz-Ebrecht, S. R., & Brydon, L. (2004) · Psychoneuroendocrinology · doi:10.1016/s0306-4530(03)00086-6 · Cited by 620 · see citing works
Kudielka, B. M., Broderick, J. E., & Kirschbaum, C. (2003) · Psychosomatic Medicine · doi:10.1097/01.psy.0000058374.50240.bf · Cited by 489 · see citing works
Buijs, R. M., Wortel, J., Van Heerikhuize, J. J., Feenstra, M. G. P., Ter Horst, G. J., Romijn, H. J., & Kalsbeek, A. (1999) · European Journal of Neuroscience · doi:10.1046/j.1460-9568.1999.00575.x · Cited by 485 · see citing works
Kunz-Ebrecht, S. R., Kirschbaum, C., Marmot, M., & Steptoe, A. (2004) · Psychoneuroendocrinology · doi:10.1016/s0306-4530(03)00072-6 · Cited by 466 · see citing works
Kudielka, B. M., & Kirschbaum, C. (2003) · Psychoneuroendocrinology · doi:10.1016/s0306-4530(02)00008-2 · Cited by 457 · see citing works
Pruessner, M., Hellhammer, D. H., Pruessner, J. C., & LUPIEN, S. J. (2003) · Psychosomatic Medicine · doi:10.1097/01.psy.0000040950.22044.10 · Cited by 434 · see citing works
Schmidt-Reinwald, A., Pruessner, J. C., Hellhammer, D. H., Federenko, I., Rohleder, N., Schürmeyer, T. H., & Kirschbaum, C. (1999) · Life Sciences · doi:10.1016/s0024-3205(99)00103-4 · Cited by 367 · see citing works
Job strain and anger expression predict early morning elevations in salivary cortisol
Steptoe, A., Cropley, M., Griffith, J., & Kirschbaum, C. (2000) · Psychosomatic Medicine · doi:10.1097/00006842-200003000-00022 · Cited by 365 · see citing works
Exploration of the awakening cortisol response in relation to diurnal cortisol secretory activity.
Edwards, S., Clow, A., Evans, P., & Hucklebridge, F. (2001) · Life Science · doi:10.1016/s0024-3205(01)00996-1 · Cited by 364 · see citing works
Self-citationDeuschle, M., Schweiger, U., Weber, B., Gotthardt, U., Körner, A., Schmider, J., Standhardt, H., Lammers, C.-H., & Heuser, I. (1997) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.82.1.3689 · Cited by 344 · see citing works
Association between time of awakening and diurnal cortisol secretory activity.
Edwards, S., Evans, P., Hucklebridge, F., & Clow, A. (2001) · Psychoneuroendocrinology · doi:10.1016/s0306-4530(01)00015-4 · Cited by 342 · see citing works
Self-citationGoodyer, I. M., Herbert, J., ALTHAM, P. M. E., Pearson, J., SECHER, S. M., & Shiers, H. M. (1996) · Psychological Medicine · doi:10.1017/s0033291700034644 · Cited by 284 · see citing works
Sleep disruption alters nocturnal ACTH and cortisol secretory patterns
Späth-Schwalbe, E., Gofferje, M., Kern, W., Born, J., & Fehm, H. L. (1991) · Biological Psychiatry · doi:10.1016/0006-3223(91)90093-2 · Cited by 266 · cited 1× · see citing works
“The finding that there is a dissociation between ACTH and cortisol at the time of the morning peak (Fehm et al., 1984; Spathschwalbe et al., 1991; Born et al., 1999) lends further support to this idea.”
Light Affects Morning Salivary Cortisol in Humans
Scheer, F. A. J. L., & Buijs, R. M. (1999) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.84.9.6102 · Cited by 258 · see citing works
de Vente, W., Olff, M., van Amsterdam, J., Kamphuis, J. H., & Emmelkamp, P. M. G. (2003) · Occupational and Environmental Medicine · doi:10.1136/oem.60.suppl_1.i54 · Cited by 245 · see citing works
Deuschle, M., Gotthardt, U., Schweiger, U., Weber, B., Körner, A., Schmider, J., Standhardt, H., Lammers, C.-H., & Heuser, I. (1997) · Life Sciences · doi:10.1016/s0024-3205(97)00926-0 · Cited by 235 · see citing works
Timing the end of nocturnal sleep
Jan Born, A., Hansen, K., Marshall, L., Mölle, M., & Fehm, H. L. (1999) · Nature · doi:10.1038/16166 · Cited by 229 · see citing works
Vasopressin-containing neurons of the suprachiasmatic nuclei inhibit corticosterone release
Kalsbeek, A., Buijs, R. M., van Heerikhuize, J. J., Arts, M., & van der Woude, T. P. (1992) · Brain Research · doi:10.1016/0006-8993(92)90927-2 · Cited by 226 · see citing works
Leproult, R., Colecchia, E. F., L’Hermite‐Balériaux, M., & Cauter, E. V. (2001) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.86.1.7102 · Cited by 214 · see citing works
Hucklebridge, F. H., Clow, A., & Evans, P. D. (1998) · International Journal of Psychophysiology · doi:10.1016/s0167-8760(98)00042-7 · Cited by 201 · see citing works
Self-citationUpham, B. L., Deocampo, N. D., Wurl, B., & Trosko, J. E. (1998) · International Journal of Cancer · doi:10.1002/(sici)1097-0215(19981109)78:4 · Cited by 180 · see citing works
Free cortisol awakening responses are influenced by awakening time
Federenko, I., Wüst, S., Hellhammer, D. H., Dechoux, R., Kumsta, R., & Kirschbaum, C. (2004) · Psychoneuroendocrinology · doi:10.1016/s0306-4530(03)00021-0 · Cited by 173 · see citing works
Petrovsky, N., & Harrison, L. C. (1997) · The Journal of Immunology · doi:10.4049/jimmunol.158.11.5163 · Cited by 168 · see citing works
Suprachiasmatic nucleus lesion increases corticosterone secretion
Buijs, R. M., Kalsbeek, A., van der Woude, T. P., van Heerikhuize, J. J., & Shinn, S. (1993) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.1993.264.6.r1186 · Cited by 149 · see citing works
Touitou, Y., Bogdan, A., Lévi, F., Benavides, M., & Auzéby, A. (1996) · British Journal of Cancer · doi:10.1038/bjc.1996.524 · Cited by 144 · see citing works
Kalsbeek, A., van der Vliet, J., & Buijs, R. M. (1996) · Journal of Neuroendocrinology · doi:10.1046/j.1365-2826.1996.04597.x · Cited by 138 · see citing works
Waye, K. P., Clow, A., Edwards, S., Hucklebridge, F. H., & Rylander, R. (2002) · Life Sciences · doi:10.1016/s0024-3205(02)02336-6 · Cited by 123 · see citing works
Self-citationThe effect of dawn simulation on the cortisol response to awakening in healthy participants
Thorn, L., Hucklebridge, F. H., Esgate, A., Evans, P. D., & Clow, A. (2003) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2003.08.005 · Cited by 111 · see citing works
Self-citationBuijs, R. M., Wortel, J., van Heerikhuize, J. J., & Kalsbeek, A. (1997) · Brain Research · doi:10.1016/s0006-8993(97)00234-5 · Cited by 103 · see citing works
Increased Diurnal Plasma Concentrations of Cortisone in Depressed Patients
Weber, B., Lewicka, S., Deuschle, M., Colla, M., Vecsei, P., & Heuser, I. (2000) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.85.3.6469 · Cited by 92 · see citing works
Edwards, S., Hucklebridge, F., Clow, A., & Evans, P. (2003) · Psychosomatic Medicine · doi:10.1097/01.psy.0000033123.70631.8e · Cited by 79 · see citing works
Self-citationHigh levels of cortisol among adolescent offspring of parents with bipolar disorder: a pilot study
Ellenbogen, M. A., Hodgins, S., & Walker, C. D. (2003) · Psychoneuroendocrinology · doi:10.1016/s0306-4530(02)00135-x · Cited by 77 · see citing works
Dijkstra, I., Binnekade, R., & Tilders, F. J. H. (1996) · Endocrinology · doi:10.1210/endo.137.2.8593800 · Cited by 75 · see citing works
Evidence for Extrapituitary Mechanisms Mediating the Morning Peak of Plasma Cortisol in Man*
Fehm, H. L., Klein, E., Holl, R. W., & Voigt, K. H. (1984) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-58-3-410 · Cited by 69 · see citing works
Ciocca, D., Maurel, D., & Bosler, O. (2001) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.2001.280.2.e260 · Cited by 69 · see citing works
The awakening cortisol response and blood glucose levels
Hucklebridge, F. H., Clow, A., Abeyguneratne, T., Huezo-Diaz, P., & Evans, P. (1999) · Life Sciences · doi:10.1016/s0024-3205(99)00019-3 · Cited by 64 · see citing works
Self-citationThe Cortisol Response to Normal and Nocturnal Awakening
Hucklebridge, F., Clow, A., Rahman, H., & Evans, P. (2000) · Journal of Psychophysiology · doi:10.1027//0269-8803.14.1.24 · Cited by 51 · see citing works
Self-citationAn inter-laboratory comparison for determination of cortisol in saliva
Garde, A. H., Hansen, �. M., & Nikolajsen, T. B. (2003) · Accreditation and Quality Assurance · doi:10.1007/s00769-002-0548-x · Cited by 48 · see citing works
Cortisol in urine and saliva: relations to the intima media thickness, IMT
Eller, N. H., Netterstrøm, B., & Hansen, Å. M. (2001) · Atherosclerosis · doi:10.1016/s0021-9150(01)00487-7 · Cited by 48 · see citing works
Hartog, H. M. D., Nicolson, N. A., Derix, M. M. A., van Bemmel, A. L., Kremer, B., & Jolles, J. (2003) · Biological Psychology · doi:10.1016/s0301-0511(03)00050-4 · Cited by 41 · see citing works
The awakening cortisol response
Hucklebridge, F. H., Mellins, J., Evans, P., & Clow, A. (2002) · Life Sciences · doi:10.1016/s0024-3205(02)01726-5 · Cited by 40 · see citing works
Self-citationWolf, J. M., & Saucier, E. (2013) · Springer eBooks · doi:10.1007/978-1-4419-1005-9_481 · Cited by 34 · see citing works
Hucklebridge, F. H., Sen, S., Evans, P. D., & Clow, A. (1998) · Life Sciences · doi:10.1016/s0024-3205(98)00213-6 · Cited by 24 · see citing works
Self-citationBrooke-Wavell, K. S. F., Clow, A., Ghazi‐Noori, S., Evans, P., & Hucklebridge, F. H. (2002) · Calcified Tissue International · doi:10.1007/s00223-001-2085-8 · Cited by 18 · see citing works
Self-citationDiurnal neuroendocrine and autonomic function in acute and remitted depressed male patients
Trestman, R. L., Yehuda, R., Coccaro, E. F., Horvath, T., Knott, P. J., Gabriel, S. M., & Siever, L. J. (1995) · Biological Psychiatry · doi:10.1016/0006-3223(94)00184-5 · Cited by 15 · see citing works
Schulz (1998) · doi:10.1002/(sici)1099-1700(199804)14:2
Flagged first, then by citations
Cited by
Sorted by citations
Salivary cortisol as a biomarker in stress research
Hellhammer, D. H., Wüst, S., & Kudielka, B. M. (2009) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2008.10.026 · Cited by 1,925 · see citing works
The cortisol awakening response (CAR): Facts and future directions
Fries, E., Dettenborn, L., & Kirschbaum, C. (2009) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2008.03.014 · Cited by 1,188 · see citing works
Cortisol awakening response and psychosocial factors: a systematic review and meta-analysis
Chida, Y., & Steptoe, A. (2009) · Biological Psychology · doi:10.1016/j.biopsycho.2008.10.004 · Cited by 1,032 · see citing works
Assessment of the cortisol awakening response: Expert consensus guidelines
Stalder, T., Kirschbaum, C., Kudielka, B. M., Adam, E. K., Pruessner, J. C., Wüst, S., Dockray, S., Smyth, N., Evans, P., Hellhammer, D. H., et al. (2016) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2015.10.010 · Cited by 967 · see citing works
Self-citationMelamed, S., Shirom, A., Toker, S., Berliner, S., & Shapira, I. (2006) · Psychological Bulletin · doi:10.1037/0033-2909.132.3.327 · Cited by 943 · see citing works
Assessing salivary cortisol in large-scale, epidemiological research
Adam, E. K., & Kumari, M. (2009) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2009.06.011 · Cited by 936 · see citing works
Adam, E. K., Quinn, M. E., Tavernier, R., McQuillan, M. T., Dahlke, K. A., & Gilbert, K. E. (2017) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2017.05.018 · Cited by 905 · see citing works
Day-to-day dynamics of experience–cortisol associations in a population-based sample of older adults
Adam, E. K., Hawkley, L. C., Kudielka, B. M., & Cacioppo, J. T. (2006) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.0605053103 · Cited by 782 · see citing works
The cortisol awakening response: More than a measure of HPA axis function
Clow, A., Hucklebridge, F., Stalder, T., Evans, P., & Thorn, L. (2010) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2009.12.011 · Cited by 635 · see citing works
Self-citationThe Functional and Clinical Significance of the 24-Hour Rhythm of Circulating Glucocorticoids
Oster, H., Challet, E., Ott, V., Arvat, E., de Kloet, E. R., Dijk, D.-J., Lightman, S., Vgontzas, A., & Van Cauter, E. (2017) · Endocrine Reviews · doi:10.1210/er.2015-1080 · Cited by 548 · see citing works
Hellhammer, J., Fries, E., Schweisthal, O. W., Schlotz, W., Stone, A. A., & Hagemann, D. (2007) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2006.10.005 · Cited by 540 · see citing works
The evidence for a neurobiological model of childhood antisocial behavior
van Goozen, S. H. M., Fairchild, G., Snoek, H., & Harold, G. T. (2007) · Psychological Bulletin · doi:10.1037/0033-2909.133.1.149 · Cited by 475 · see citing works
Prenatal Anxiety Predicts Individual Differences in Cortisol in Pre-Adolescent Children
O’Connor, T. G., Ben‐Shlomo, Y., Heron, J., Golding, J., Adams, D., & Glover, V. A. S. (2005) · Biological Psychiatry · doi:10.1016/j.biopsych.2005.03.032 · Cited by 457 · see citing works
Is the cortisol awakening rise a response to awakening?
Wilhelm, I., Born, J., Kudielka, B. M., Schlotz, W., & Wüst, S. (2007) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2007.01.008 · Cited by 454 · see citing works
Impact of Metabolic Syndrome on Cognition and Brain: A Selected Review of the Literature
Yates, K. F., Sweat, V., Yau, P. L., Turchiano, M. M., & Convit, A. (2012) · Arteriosclerosis, Thrombosis, and Vascular Biology · doi:10.1161/atvbaha.112.252759 · Cited by 444 · see citing works
Kudielka, B. M., & Wüst, S. (2010) · Stress · doi:10.3109/10253890902874913 · Cited by 424 · see citing works
Miller, R., Plessow, F., Kirschbaum, C., & Stalder, T. (2013) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000002 · Cited by 376 · see citing works
A systematic review of randomised control trials on the effects of yoga on stress measures and mood
Pascoe, M. C., & Bauer, I. E. (2015) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2015.07.013 · Cited by 366 · see citing works
Daubenmier, J., Kristeller, J., Hecht, F. M., Maninger, N., Kuwata, M., Jhaveri, K., Lustig, R. H., Kemeny, M., Karan, L., & Epel, E. (2011) · Journal of Obesity · doi:10.1155/2011/651936 · Cited by 322 · see citing works
Goodman, W. K., Janson, J., & Wolf, J. M. (2017) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2017.02.030 · Cited by 317 · see citing works
Prospective prediction of major depressive disorder from cortisol awakening responses in adolescence
Adam, E. K., Doane, L. D., Zinbarg, R. E., Mineka, S., Craske, M. G., & Griffith, J. W. (2010) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2009.12.007 · Cited by 315 · see citing works
Cortisol and depression: three questions for psychiatry
Herbert, J. (2013) · Psychological Medicine · doi:10.1017/s0033291712000955 · Cited by 301 · see citing works
Measurement and meaning of salivary cortisol: A focus on health and disease in children
Jessop, D. S., & Turner‐Cobb, J. M. (2008) · Stress · doi:10.1080/10253890701365527 · Cited by 284 · see citing works
Nicolson, N. A. (2008) · Sage eBooks · doi:10.4135/9781412976244.n3 · Cited by 286 · see citing works
Increased salivary cortisol after waking in depression
Bhagwagar, Z., Hafizi, S., & Cowen, P. J. (2005) · Psychopharmacology · doi:10.1007/s00213-005-0062-z · Cited by 281 · see citing works
Mondelli, V., Dazzan, P., Hepgul, N., Di Forti, M., Aas, M., D'Albenzio, A., Di Nicola, M., Fisher, H., Handley, R., Marques, T. R., et al. (2010) · Schizophrenia Research · doi:10.1016/j.schres.2009.08.013 · Cited by 278 · see citing works
Aging and the HPA axis: Stress and resilience in older adults
Gaffey, A. E., Bergeman, C. S., Clark, L. A., & Wirth, M. M. (2016) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2016.05.036 · Cited by 273 · see citing works
Childhood Trauma and Risk for Chronic Fatigue Syndrome - Association With Neuroendocrine Dysfunction
Heim, C. C., Nater, U. M., & al, E. (2009) · PubMed · doi:10.1001/archgenpsychiatry.2008.508 · Cited by 260 · see citing works
Racial/ethnic differences in cortisol diurnal rhythms in a community sample of adolescents.
Desantis, A., Adam, E., Doane, L. D., Mineka, S., Zinbarg, R., & Craske, M. (2007) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2007.03.006 · Cited by 251 · see citing works
Cortisol as a marker for improvement in mindfulness-based stress reduction
Matousek, R. H., Dobkin, P. L., & Pruessner, J. (2010) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2009.06.004 · Cited by 233 · see citing works
Kumari, M., Badrick, E., Ferrie, J., Perski, A., Marmot, M., & Chandola, T. (2009) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2009-0555 · Cited by 229 · see citing works
Salivary Cortisol in Ambulatory Assessment—Some Dos, Some Don’ts, and Some Open Questions
Kudielka, B. M., Gierens, A., Hellhammer, D. H., Wüst, S., & Schlotz, W. (2012) · Psychosomatic Medicine · doi:10.1097/psy.0b013e31825434c7 · Cited by 225 · see citing works
Smoking, cortisol and nicotine
Steptoe, A., & USSHER, M. H. (2005) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2005.10.011 · Cited by 225 · see citing works
Effect of service dogs on salivary cortisol secretion in autistic children
Viau, R., Arsenault‐Lapierre, G., Fecteau, S.-M., Champagne, N., Walker, C., & LUPIEN, S. J. (2010) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2010.02.004 · Cited by 224 · see citing works
Rosmalen, J. G. M., Oldehinkel, A. J., Ormel, J., de Winter, A. F., Buitelaar, J. K., & Verhulst, F. C. (2005) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2004.12.007 · Cited by 222 · see citing works
Subjective socioeconomic position, gender and cortisol responses to waking in an elderly population
Wright, C. E., & Steptoe, A. (2005) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2005.01.007 · Cited by 218 · see citing works
Padden, C., & James, J. E. (2017) · Journal of Developmental and Physical Disabilities · doi:10.1007/s10882-017-9547-z · Cited by 222 · see citing works
Morning cortisol levels in schizophrenia and bipolar disorder: a meta-analysis
Girshkin, L., Matheson, S. L., Shepherd, A. M., & Green, M. J. (2014) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2014.07.013 · Cited by 215 · see citing works
Interventions to Improve Cortisol Regulation in Children: A Systematic Review
Slopen, N., McLaughlin, K. A., & Shonkoff, J. P. (2014) · Pediatrics · doi:10.1542/peds.2013-1632 · Cited by 211 · see citing works
Steptoe, A., Gibson, E. L., Hamer, M., & Wardle, J. (2006) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2006.10.001 · Cited by 210 · see citing works
Circadian regulation of cortisol after hippocampal damage in humans
Buchanan, T. W., Kern, S., Allen, J. S., Tranel, D., & Kirschbaum, C. (2004) · Biological Psychiatry · doi:10.1016/j.biopsych.2004.08.014 · Cited by 206 · see citing works
Does cellular aging relate to patterns of allostasis?
Tomiyama, A. J., O’Donovan, A., Lin, J., Puterman, E. M., Lazaro, A., Chan, J. L., Dhabhar, F. S., Wolkowitz, O. M., Kirschbaum, C., Blackburn, E. H., et al. (2011) · Physiology & Behavior · doi:10.1016/j.physbeh.2011.11.016 · Cited by 206 · see citing works
Low calorie dieting increases cortisol
Tomiyama, A. J., Mann, T., Vinas, D., Hunger, J. M., DeJager, J., & Taylor, S. E. (2010) · Psychosomatic Medicine · doi:10.1097/psy.0b013e3181d9523c · Cited by 203 · see citing works
Hansen, Å. M., Garde, A. H., & Persson, R. (2008) · Scandinavian Journal of Clinical and Laboratory Investigation · doi:10.1080/00365510701819127 · Cited by 198 · see citing works
Petrelluzzi, K. F. S., Garcia, M. C., Petta, C. A., Grassi-Kassisse, D. M., & Spadari-Bratfisch, R. C. (2008) · Stress · doi:10.1080/10253890701840610 · Cited by 196 · see citing works
Psychophysiological stress in tennis players during the first single match of a tournament
Filaire, E., Alix, D., Ferrand, C., & Verger, M. (2008) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2008.08.022 · Cited by 199 · see citing works
Vreeburg, S. A., Kruijtzer, B. P., van Pelt, J., van Dyck, R., DeRijk, R. H., Hoogendijk, W. J. G., Smit, J. H., Zitman, F. G., & Penninx, B. W. J. H. (2009) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2009.04.024 · Cited by 193 · see citing works
Bellingrath, S., Weigl, T., & Kudielka, B. M. (2008) · Biological Psychology · doi:10.1016/j.biopsycho.2008.01.006 · Cited by 192 · see citing works
Violanti, J. M., Burchfiel, C. M., Miller, D. B., Andrew, M. E., Dorn, J. M., Wactawski‐Wende, J., Beighley, C. M., Pierino, K., Joseph, P. N., Vena, J. E., et al. (2005) · Annals of Epidemiology · doi:10.1016/j.annepidem.2005.07.054 · Cited by 187 · see citing works
The cortisol awakening response – Applications and implications for sleep medicine
Elder, G. J., Wetherell, M. A., Barclay, N. L., & Ellis, J. G. (2013) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2013.05.001 · Cited by 190 · see citing works
Kudielka, B. M., Federenko, I. S., Hellhammer, D. H., & Wüst, S. (2005) · Biological Psychology · doi:10.1016/j.biopsycho.2005.08.003 · Cited by 176 · see citing works
Fetal Growth and the Adrenocortical Response to Psychological Stress
Jones, A., Godfrey, K. M., Wood, P., Osmond, C., Goulden, P., & Phillips, D. I. W. (2006) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2005-2077 · Cited by 178 · see citing works
Hajat, A., Roux, A. V. D., Franklin, T. G., Seeman, T. E., Shrager, S., Ranjit, N., Castro‐Diehl, C., Watson, K. E., Sánchez, B. N., & Kirschbaum, C. (2010) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2009.12.009 · Cited by 181 · see citing works
Entringer, S., Buß, C., Shirtcliff, E. A., Cammack, A. L., Yim, I. S., Chicz-DeMet, A., Sandman, C. A., & Wadhwa, P. D. (2010) · Stress · doi:10.3109/10253890903349501 · Cited by 180 · see citing works
Vriendt, T. D., Moreno, L. A., & Henauw, S. D. (2009) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2009.02.009 · Cited by 178 · see citing works
Almeida, D. M., Piazza, J. R., & Stawski, R. S. (2009) · Psychology and Aging · doi:10.1037/a0017910 · Cited by 179 · see citing works
de Kloet, C. S., Vermetten, E. H. G. J. M., Heijnen, C. J., Geuze, E., Lentjes, E. G. W. M., & Westenberg, H. G. M. (2007) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2006.12.009 · Cited by 177 · see citing works
Clinical experimental stress studies: methods and assessment
Bali, A., & Jaggi, A. S. (2015) · Reviews in the Neurosciences · doi:10.1515/revneuro-2015-0004 · Cited by 175 · see citing works
The morning salivary cortisol response in burnout
Grossi, G., Perski, A., Ekstedt, M., Johansson, T., Lindström, M., & Holm, K. (2005) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2005.02.009 · Cited by 174 · see citing works
Cima, M., Smeets, T., & Jelícic, M. (2008) · Biological Psychology · doi:10.1016/j.biopsycho.2007.12.011 · Cited by 173 · see citing works
Fairchild, G. F., van Goozen, S. H. M., Stollery, S. J., Brown, J., GARDINER, J. S., Herbert, J., & Goodyer, I. M. (2008) · Biological Psychiatry · doi:10.1016/j.biopsych.2008.05.022 · Cited by 171 · see citing works
The Cortisol Awakening Response in Context
Clow, A., Hucklebridge, F. H., & Thorn, L. (2010) · International review of neurobiology · doi:10.1016/s0074-7742(10)93007-9 · Cited by 170 · see citing works
Self-citationInfluence of mindfulness practice on cortisol and sleep in long-term and short-term meditators
Brand, S., Holsboer-Trachsler, E., Naranjo, J. R., & Schmidt, S. (2012) · Neuropsychobiology · doi:10.1159/000330362 · Cited by 169 · see citing works
Testosterone responsiveness to winning and losing experiences in female soccer players
Oliveira, T., Gouveia, M. J., & Oliveira, R. F. (2009) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2009.02.006 · Cited by 163 · see citing works
Sanada, K., Montero-Marin, J., Alda Díez, M., Salas-Valero, M., Pérez-Yus, M. C., Morillo, H., Demarzo, M. M. P., García-Toro, M., & García-Campayo, J. (2016) · Frontiers in Physiology · doi:10.3389/fphys.2016.00471 · Cited by 161 · see citing works
Childhood trauma and diurnal cortisol disruption in fibromyalgia syndrome
Weissbecker, I., Floyd, A., Dedert, E. A., Salmon, P. M., & Sephton, S. E. (2005) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2005.08.009 · Cited by 161 · see citing works
Decreased cortisol awakening response after early loss experience
Meinlschmidt, G., & Heim, C. C. (2005) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2005.01.006 · Cited by 160 · see citing works
Dressle, R. J., Feige, B., Spiegelhalder, K., Schmucker, C., Benz, F., Mey, N. C., & Riemann, D. (2022) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2022.101588 · Cited by 161 · see citing works
Cortisol awakening response is elevated in acute coronary syndrome patients with type-D personality
Whitehead, D. L., Perkins-Porras, L., Strike, P. C., Magid, K. S., & Steptoe, A. (2007) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2006.11.005 · Cited by 159 · see citing works
Dockray, S., Bhattacharyya, M. R., Molloy, G. J., & Steptoe, A. (2007) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2007.10.001 · Cited by 157 · see citing works
Neuroendocrine and Immune Contributors to Fatigue
Silverman, M. N., Heim, C. C., Nater, U. M., Marques, A. H., & Sternberg, E. M. (2010) · PM&R · doi:10.1016/j.pmrj.2010.04.008 · Cited by 157 · see citing works
Salivary Cortisol Is Related to Atherosclerosis of Carotid Arteries
Dekker, M. J. H. J., Koper, J. W., van Aken, M. O., Pols, H. A. P., Albert Hofman, D., de Jong, F. H., Kirschbaum, C., Witteman, J. C. M., Lamberts, S. W. J., & Tiemeier, H. W. (2008) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-0496 · Cited by 154 · see citing works
The cortisol awakening response is blunted in psychotherapy inpatients suffering from depression
Huber, T. J., Issa, K., Schik, G., & Wolf, O. T. (2006) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2006.03.005 · Cited by 152 · see citing works
A field (researcher's) guide to cortisol: tracking HPA axis functioning in everyday life
Saxbe, D. (2008) · Health Psychology Review · doi:10.1080/17437190802530812 · Cited by 150 · see citing works
Morningness-eveningness, habitual sleep-wake variables and cortisol level
Randler, C., & Schaal, S. (2010) · Biological Psychology · doi:10.1016/j.biopsycho.2010.04.006 · Cited by 150 · see citing works
Muehlenbein, M. P., Ancrenaz, M., Sakong, R., Ambu, L. N., Prall, S. P., Fuller, G. A., & Raghanti, M. A. (2012) · PLoS ONE · doi:10.1371/journal.pone.0033357 · Cited by 145 · see citing works
Papp, L. M., Pendry, P., & Adam, E. K. (2009) · Journal of Family Psychology · doi:10.1037/a0017147 · Cited by 146 · see citing works
Fibromyalgia syndrome is associated with hypocortisolism
Riva, R., Mork, P. J., Westgaard, R. H., Rø, M., & Lundberg, U. (2010) · International Journal of Behavioral Medicine · doi:10.1007/s12529-010-9097-6 · Cited by 143 · see citing works
Summary cortisol reactivity indicators: Interrelations and meaning
Khoury, J. E., González, A., Levitan, R. D., Pruessner, J. C., Chopra, K. K., Basile, V. S., Masellis, M., Goodwill, A. M., & Atkinson, L. R. (2015) · Neurobiology of Stress · doi:10.1016/j.ynstr.2015.04.002 · Cited by 144 · see citing works
Day-to-day variation in saliva cortisol—Relation with sleep, stress and self-rated health
Dahlgren, A., Kecklund, G., Theorell, T., & Åkerstedt, T. (2009) · Biological Psychology · doi:10.1016/j.biopsycho.2009.07.001 · Cited by 141 · see citing works
A blunted cortisol awakening response and hippocampal atrophy in type 2 diabetes mellitus
Bruehl, H., Wolf, O. T., & Convit, A. (2009) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2008.12.010 · Cited by 142 · see citing works
Blomqvist, M., Holmberg, K., Lindblad, F., Fernell, E., Ek, U., & Dahllöf, G. (2007) · European Journal of Oral Sciences · doi:10.1111/j.1600-0722.2007.00423.x · Cited by 139 · see citing works
Michaud, K., Matheson, K., Kelly, O., & Anisman, H. (2008) · Stress · doi:10.1080/10253890701727874 · Cited by 142 · see citing works
Karlamangla, A. S., Friedman, E. M., Seeman, T. E., Stawksi, R. S., & Almeida, D. M. (2013) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2013.06.010 · Cited by 141 · see citing works
Suspected non-adherence and weekend versus week day differences in the awakening cortisol response
Thorn, L., Hucklebridge, F. H., Evans, P., & Clow, A. (2006) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2006.05.012 · Cited by 138 · see citing works
Self-citationExtended work availability and its relation with start-of-day mood and cortisol.
Dettmers, J., Vahle‐Hinz, T., Bamberg, E., Friedrich, N., & Keller, M. (2015) · Journal of Occupational Health Psychology · doi:10.1037/a0039602 · Cited by 140 · see citing works
Inter-relation between autonomic and HPA axis activity in children and adolescents
Rotenberg, S., & McGrath, J. J. (2016) · Biological Psychology · doi:10.1016/j.biopsycho.2016.01.015 · Cited by 138 · see citing works
Salivary cortisol and memory function in human aging
Li, G., Cherrier, M. M., Tsuang, D. W., Petrie, E. C., Colasurdo, E. A., Craft, S., Schellenberg, G. D., Peskind, E. R., Raskind, M. A., & Wilkinson, C. W. (2005) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2005.09.031 · Cited by 135 · see citing works
González, A., Jenkins, J. M., Steiner, M. S., & Fleming, A. S. (2008) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2008.08.012 · Cited by 136 · see citing works
Sjögren, E., Leanderson, P., & Kristenson, M. (2006) · International Journal of Behavioral Medicine · doi:10.1207/s15327558ijbm1303_2 · Cited by 135 · see citing works
Hypothalamic pituitary adrenal axis functioning in reactive and proactive aggression in children
Lopez-Duran, N. L., Olson, S. L., Hajal, N. J., Felt, B. T., & Vazquez, D. M. (2009) · Journal of Abnormal Child Psychology · doi:10.1007/s10802-008-9263-3 · Cited by 134 · see citing works
Cortisol secretion and fatigue: Associations in a community based cohort
Meena Kumari, B., Badrick, E., Chandola, T., Adam, E. K., Stafford, M., Marmot, M. G., Kirschbaum, C., & Mika Kivimaki, B. (2009) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2009.05.001 · Cited by 135 · see citing works
Sleep disturbances, TBI and PTSD: Implications for treatment and recovery
Stavitsky, K., Kark, S. M., Gehrman, P., & Bogdanova, Y. (2015) · Clinical Psychology Review · doi:10.1016/j.cpr.2015.05.008 · Cited by 136 · see citing works
Social Psychophysiology for Social and Personality Psychology
Blascovich, J., Vanman, E. J., Mendes, W. B., & Dickerson, S. S. (2011) · SAGE Publications Ltd eBooks · doi:10.4135/9781446287842 · Cited by 129 · see citing works
The cortisol awakening response (CAR) across the female menstrual cycle
Wolfram, M., Bellingrath, S., & Kudielka, B. M. (2011) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2010.12.006 · Cited by 130 · see citing works
DeSantis, A. S., Diez–Roux, A. V., Hajat, A., Aiello, A. E., Golden, S. H., Jenny, N. S., Seeman, T. E., & Shea, S. (2011) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2011.11.009 · Cited by 124 · see citing works
Seasonal Variation in Human Salivary Cortisol Concentration
Persson, R., Garde, A. H., Hansen, Å. M., Österberg, K., Larsson, B. K., Ørbæk, P., & Karlson, B. (2008) · Chronobiology International · doi:10.1080/07420520802553648 · Cited by 121 · see citing works
Psychosocial factors at home and at work and levels of salivary cortisol
Eller, N. H., Netterstrøm, B., & Hansen, Å. M. (2006) · Biological Psychology · doi:10.1016/j.biopsycho.2006.05.003 · Cited by 117 · see citing works
Shea, A. K., Streiner, D. L., Fleming, A. S., Kamath, M. V., Broad, K., & Steiner, M. S. (2007) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2007.07.006 · Cited by 118 · see citing works
Lasikiewicz, N., Hendrickx, H., Talbot, D., & Dye, L. (2007) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2007.10.013 · Cited by 117 · see citing works
- Authors
- Clow, A., Thorn, L., Evans, P., & Hucklebridge, F.
- Affiliations
- University of Westminster (GB)
- Venue
- Stress
- Publisher
- Informa UK Limited
- Published
- 2004-03
- Volume
- 7
- Issue
- 1
- Pages
- 29-37
- ISSN
- 1025-3890 (ISSN-L)
- 1607-8888
- OpenAlex
- W1973501977
- Cited by
- 856
- References
- 55
- Citations by year
- 2026: 10 · 2025: 19 · 2024: 14 · 2023: 21 · 2022: 32 · 2021: 34 · 2020: 43 · 2019: 47 · 2018: 31 · 2017: 47 · 2016: 54 · 2015: 51 · 2014: 55 · 2013: 47 · 2012: 47
- FWCI
- 2.37
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Stress (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, cortisol secretion, reference values, gender differences, age effects, light exposure, participant adherence, positive affect, immune regulation, mind-body problem
- MeSH terms
- Adrenal Cortex, Arousal, Circadian Rhythm, Humans, Hydrocortisone
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
