Cited by 856Stress Responses and CortisolAdrenal Hormones and DisordersCircadian rhythm and melatonin

The DOI matches its Crossref record; 55 of the 55 references it cites were found in a registry or an index.

The Awakening Cortisol Response: Methodological Issues and Significance

Clow, A., Thorn, L., Evans, P., Hucklebridge, F.·2004·Stress

Open this paper in CoChat — free account

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

Crossref · 10.1080/10253890410001667205

Cites

55 of 55 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

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?

Two formulas for computation of the area under the curve represent measures of total hormone concentration versus time-dependent change
Pruessner, J. C., Kirschbaum, C., Meinlschmid, G., & Hellhammer, D. H. (2003) · Psychoneuroendocrinology · doi:10.1016/s0306-4530(02)00108-7 · Cited by 3,638
Salivary Cortisol in Psychobiological Research: An Overview
Kirschbaum, C., & Hellhammer, D. H. (2008) · Neuropsychobiology · doi:10.1159/000118611 · Cited by 1,532
Free Cortisol Levels after Awakening: A Reliable Biological Marker for the Assessment of Adrenocortical Activity
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
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
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
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
Cortisol regulation in posttraumatic stress disorder and major depression: A chronobiological analysis
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 654
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
Loneliness and neuroendocrine, cardiovascular, and inflammatory stress responses in middle-aged men and women
Steptoe, A., Owen, N., Kunz-Ebrecht, S. R., & Brydon, L. (2004) · Psychoneuroendocrinology · doi:10.1016/s0306-4530(03)00086-6 · Cited by 620
Compliance With Saliva Sampling Protocols: Electronic Monitoring Reveals Invalid Cortisol Daytime Profiles in Noncompliant Subjects
Kudielka, B. M., Broderick, J. E., & Kirschbaum, C. (2003) · Psychosomatic Medicine · doi:10.1097/01.psy.0000058374.50240.bf · Cited by 489

Show all 55 references

Research works printed but not linked: 7

10.1016/S0306- · DOI
Buijs R.M., 1993, Am. J. Physiol., 264, R1186
Goodyer I.M., 1996, Med, 26, 245
Leproult R., 2001, J. Clin. Endocrinol. Metab., 86, 151
Pruessner J.C., 1995, J. Psychophysiol., 9, 365
Thorn L., 2003, Brain Behav. Immun., 17, 211
Wust S., 2000, Noise Health, 7, 77

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
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
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
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
Self-citation
Burnout and risk of cardiovascular disease: Evidence, possible causal paths, and promising research directions.
Melamed, S., Shirom, A., Toker, S., Berliner, S., & Shapira, I. (2006) · Psychological Bulletin · doi:10.1037/0033-2909.132.3.327 · Cited by 943
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
Diurnal cortisol slopes and mental and physical health outcomes: a systematic review and meta-analysis
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
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
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
Self-citation
The 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
Several daily measurements are necessary to reliably assess the cortisol rise after awakening: State-and trait components
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
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
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 474
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
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
Human models in acute and chronic stress: Assessing determinants of individual hypothalamus–pituitary–adrenal axis activity and reactivity
Kudielka, B. M., & Wüst, S. (2010) · Stress · doi:10.3109/10253890902874913 · Cited by 424
Classification Criteria for Distinguishing Cortisol Responders From Nonresponders to Psychosocial Stress: Evaluation of Salivary Cortisol Pulse Detection in Panel Designs
Miller, R., Plessow, F., Kirschbaum, C., & Stalder, T. (2013) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000002 · Cited by 376
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
Mindfulness intervention for stress eating to reduce cortisol and abdominal fat among overweight and obese women: an exploratory randomized controlled study
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
Meta-analytical assessment of the effects of protocol variations on cortisol responses to the Trier Social Stress Test
Goodman, W. K., Janson, J., & Wolf, J. M. (2017) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2017.02.030 · Cited by 317
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
Cortisol and depression: three questions for psychiatry
Herbert, J. (2013) · Psychological Medicine · doi:10.1017/s0033291712000955 · Cited by 301
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
Measurement of Cortisol
Nicolson, N. A. (2008) · Sage eBooks · doi:10.4135/9781412976244.n3 · Cited by 288
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
Abnormal cortisol levels during the day and cortisol awakening response in first-episode psychosis: The role of stress and of antipsychotic treatment
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
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
Childhood Trauma and Risk for Chronic Fatigue Syndrome
Heim, C. C., Nater, U. M., Maloney, E. M., Boneva, R. S., Jones, J. F., & Reeves, W. C. (2009) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2008.508 · Cited by 272
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
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
Self-Reported Sleep Duration and Sleep Disturbance Are Independently Associated with Cortisol Secretion in the Whitehall II Study
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
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 238
Smoking, cortisol and nicotine
Steptoe, A., & USSHER, M. H. (2005) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2005.10.011 · Cited by 237
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 252
Determinants of salivary cortisol levels in 10–12 year old children; a population-based study of individual differences
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
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 225
Stress among Parents of Children with and without Autism Spectrum Disorder: A Comparison Involving Physiological Indicators and Parent Self-Reports
Padden, C., & James, J. E. (2017) · Journal of Developmental and Physical Disabilities · doi:10.1007/s10882-017-9547-z · Cited by 222
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
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
Neuroendocrine and cardiovascular correlates of positive affect measured by ecological momentary assessment and by questionnaire
Steptoe, A., Gibson, E. L., Hamer, M., & Wardle, J. (2006) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2006.10.001 · Cited by 210
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
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
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
Sources of biological and methodological variation in salivary cortisol and their impact on measurement among healthy adults: A review
Hansen, Å. M., Garde, A. H., & Persson, R. (2008) · Scandinavian Journal of Clinical and Laboratory Investigation · doi:10.1080/00365510701819127 · Cited by 198
Salivary cortisol concentrations, stress and quality of life in women with endometriosis and chronic pelvic pain: Research Report
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
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
Associations between sociodemographic, sampling and health factors and various salivary cortisol indicators in a large sample without psychopathology
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
Cortisol dysregulation in school teachers in relation to burnout, vital exhaustion, and effort–reward-imbalance
Bellingrath, S., Weigl, T., & Kudielka, B. M. (2008) · Biological Psychology · doi:10.1016/j.biopsycho.2008.01.006 · Cited by 192
The Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Pilot Study: Methods and Participant Characteristics
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
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 208
Morningness and eveningness: The free cortisol rise after awakening in “early birds” and “night owls”
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
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
Socioeconomic and race/ethnic differences in daily salivary cortisol profiles: The Multi-Ethnic Study of Atherosclerosis
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
Attenuation of maternal psychophysiological stress responses and the maternal cortisol awakening response over the course of human pregnancy
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 191
Chronic stress and obesity in adolescents: Scientific evidence and methodological issues for epidemiological research
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 185
Interindividual differences and intraindividual variability in the cortisol awakening response: An examination of age and gender.
Almeida, D. M., Piazza, J. R., & Stawski, R. S. (2009) · Psychology and Aging · doi:10.1037/a0017910 · Cited by 179
Enhanced cortisol suppression in response to dexamethasone administration in traumatized veterans with and without posttraumatic stress disorder
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
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 190
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
Self-reported trauma, cortisol levels, and aggression in psychopathic and non-psychopathic prison inmates
Cima, M., Smeets, T., & Jelícic, M. (2008) · Biological Psychology · doi:10.1016/j.biopsycho.2007.12.011 · Cited by 173
Cortisol Diurnal Rhythm and Stress Reactivity in Male Adolescents with Early-Onset or Adolescence-Onset Conduct Disorder
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
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 176
Self-citation
Influence 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
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
HPA axis activity in patients with chronic insomnia: A systematic review and meta-analysis of case–control studies
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
Effects of mindfulness-based interventions on salivary cortisol in healthy adults: a meta-analytical review
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
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 171
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
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 163
The cortisol awakening response in relation to objective and subjective measures of waking in the morning
Dockray, S., Bhattacharyya, M. R., Molloy, G. J., & Steptoe, A. (2007) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2007.10.001 · Cited by 161
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 167
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 158
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
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 162
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
Ape Conservation Physiology: Fecal Glucocorticoid Responses in Wild Pongo pygmaeus morio following Human Visitation
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 149
Mother-adolescent physiological synchrony in naturalistic settings: Within-family cortisol associations and moderators.
Papp, L. M., Pendry, P., & Adam, E. K. (2009) · Journal of Family Psychology · doi:10.1037/a0017147 · Cited by 151
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
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
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
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
Salivary cortisol levels and dental anxiety in children with attention deficit hyperactivity disorder
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
Impact of stressors in a natural context on release of cortisol in healthy adult humans: A meta-analysis
Michaud, K., Matheson, K., Kelly, O., & Anisman, H. (2008) · Stress · doi:10.1080/10253890701727874 · Cited by 142
Daytime trajectories of cortisol: Demographic and socioeconomic differences—Findings from the National Study of Daily Experiences
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 145
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
Self-citation
Extended 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 157
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 152
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
The relation between early life adversity, cortisol awakening response and diurnal salivary cortisol levels in postpartum women
González, A., Jenkins, J. M., Steiner, M. S., & Fleming, A. S. (2008) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2008.08.012 · Cited by 142
Diurnal saliva cortisol levels and relations to psychosocial factors in a population sample of middle-aged swedish men and women
Sjögren, E., Leanderson, P., & Kristenson, M. (2006) · International Journal of Behavioral Medicine · doi:10.1207/s15327558ijbm1303_2 · Cited by 135
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
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
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 143
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 132
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
Associations of salivary cortisol levels with inflammatory markers: The Multi-Ethnic Study of Atherosclerosis
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 128
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
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
The effect of depression, anxiety and early life trauma on the cortisol awakening response during pregnancy: Preliminary results
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 119
Exploration of basal diurnal salivary cortisol profiles in middle-aged adults: Associations with sleep quality and metabolic parameters
Lasikiewicz, N., Hendrickx, H., Talbot, D., & Dye, L. (2007) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2007.10.013 · Cited by 122

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
DOI: 10.1080/10253890410001667205
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

The Awakening Cortisol Response: Methodological Issues and Significance

Abstract

Overview

Integrity signals

Verification

Claims the paper makes

Claims other papers make about this one

Citations

Cites

Cited by

Related

Metadata

Record

About these checks