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Updated: May 10, 2026

A Modified Trier Social Stress Test for Vulnerable Mexican American Adolescents
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State variation in the cortisol awakening response.

Robin Law1, Frank Hucklebridge, Lisa Thorn

  • 1Department of Psychology, University of Westminster, London, UK.

Stress (Amsterdam, Netherlands)
|June 29, 2013
PubMed
Summary

The cortisol awakening response (CAR) is a key circadian rhythm marker. This review synthesizes research on daily CAR variations, revealing factors influencing it and its impact on functioning.

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Area of Science:

  • Endocrinology
  • Chronobiology
  • Psychoneuroendocrinology

Background:

  • The cortisol awakening response (CAR) is a well-documented circadian cortisol secretion pattern.
  • Since its 1997 identification, CAR has been extensively studied as a biomarker for adrenocortical activity.
  • Most research focuses on CAR differences between healthy and clinical groups, not daily variations.

Purpose of the Study:

  • To review studies examining day-to-day variations in the CAR within healthy individuals.
  • To synthesize current understanding of factors influencing CAR and its impact on daily functioning.
  • To identify gaps in knowledge and suggest future research directions for CAR.

Main Methods:

  • Systematic review of literature focusing on day-to-day variation in the cortisol awakening response.
  • Analysis of studies investigating correlates of CAR fluctuations in healthy populations.
  • Synthesis of findings regarding state factors affecting CAR and its functional consequences.

Main Results:

  • Limited studies (approx. 25) have explored day-to-day CAR variability.
  • Emerging evidence suggests state factors influence CAR and its impact on daily functioning.
  • CAR shows potential as a biomarker in psychophysiological and epidemiological research.

Conclusions:

  • Understanding daily CAR fluctuations is crucial for its application as a biomarker.
  • Further research is needed to clarify CAR regulation and its functional significance.
  • This review highlights the CAR's promise in understanding health and disease.