Daily Life Stress and the Cortisol Awakening Response: Testing the Anticipation Hypothesis

PLOS ONE, Dec 2019

The cortisol awakening response (CAR) is a distinct facet of the circadian cortisol rhythm associated with various health conditions and risk factors. It has repeatedly been suggested that the CAR could be a result of the anticipated demands of the upcoming day (stress anticipation) and could support coping with daily life stress. In a sample of 23 healthy participants CARs were assessed on two consecutive days by measures of salivary cortisol upon awakening (S1) and 30 and 45 minutes later, which were aggregated to the area under the curve increase (AUCI). Stress anticipation was assessed immediately after awakening. On the same days, daily life stress and distress were assessed six times per day based on a quasi-randomized design using handheld computers. Associations were tested by day using regression analysis and standard multilevel/mixed effects models for longitudinal data. The CAR AUCI moderated the effect of daily life stress on distress; higher CAR increases were associated with attenuated distress responses to daily life stress on both days (day 1: pā€Š=ā€Š.039; day 2: pā€Š=ā€Š.004) adjusted for age, gender, sleep quality, time of awakening and oral contraceptive use. Lagged-effects and redundancy models showed that this effect was not due to prior-day CAR increases but specific for same day CARs. On day 2, associations between daily life stress and distress were stronger when individuals showed a higher S1 cortisol level, but this effect was similar for S1 on day 1, and the day 2 effect of S1 became non-significant when S1 on day 1 was controlled. No associations were found between stress anticipation and CARs. Findings indicate that the CAR increase is associated with successful coping with same-day daily life stress.

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Daily Life Stress and the Cortisol Awakening Response: Testing the Anticipation Hypothesis

Citation: Powell DJ, Schlotz W ( Daily Life Stress and the Cortisol Awakening Response: Testing the Anticipation Hypothesis Daniel J. Powell 0 Wolff Schlotz 0 Tobias Deschner, Max Planck Institute for Evolutionary Anthropology, Germany 0 1 Faculty of Social and Human Sciences, University of Southampton , Southampton , United Kingdom , 2 Institute of Psychology, University of Regensburg , Regensburg , Germany The cortisol awakening response (CAR) is a distinct facet of the circadian cortisol rhythm associated with various health conditions and risk factors. It has repeatedly been suggested that the CAR could be a result of the anticipated demands of the upcoming day (stress anticipation) and could support coping with daily life stress. In a sample of 23 healthy participants CARs were assessed on two consecutive days by measures of salivary cortisol upon awakening (S1) and 30 and 45 minutes later, which were aggregated to the area under the curve increase (AUCI). Stress anticipation was assessed immediately after awakening. On the same days, daily life stress and distress were assessed six times per day based on a quasi-randomized design using handheld computers. Associations were tested by day using regression analysis and standard multilevel/mixed effects models for longitudinal data. The CAR AUCI moderated the effect of daily life stress on distress; higher CAR increases were associated with attenuated distress responses to daily life stress on both days (day 1: p = .039; day 2: p = .004) adjusted for age, gender, sleep quality, time of awakening and oral contraceptive use. Lagged-effects and redundancy models showed that this effect was not due to prior-day CAR increases but specific for same day CARs. On day 2, associations between daily life stress and distress were stronger when individuals showed a higher S1 cortisol level, but this effect was similar for S1 on day 1, and the day 2 effect of S1 became non-significant when S1 on day 1 was controlled. No associations were found between stress anticipation and CARs. Findings indicate that the CAR increase is associated with successful coping with same-day daily life stress. - Funding: This study was financially supported by the School of Psychology, University of Southampton. Publication of this work was supported by the German Research Foundation (DFG) within the funding programme Open Access Publishing. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. The cortisol awakening response (CAR) is a distinct facet of the circadian cortisol rhythm, an increase of cortisol within the first hour after awakening that is separate from the cortisol increase during the second half of the night [1]. It has been suggested that the CAR is the result of an interaction of hypothalamus-pituitaryadrenal (HPA) axis activity, regional brain activation, and changes in adrenal sensitivity around the process of awakening [2]. Since its initial systematic description [3] the CAR has received considerable research interest. Studies found evidence for associations with a variety of psychosocial factors [4] as well as physical and mental disorders and associated risk factors. For example, increased CARs were observed in relapsing-remitting multiple sclerosis [5], upper respiratory symptoms [6], visceral obesity [7], and women with the metabolic syndrome [8]. In contrast, decreased CARs were observed in patients with type 2 diabetes mellitus [9], chronic fatigue syndrome [10,11], systemic hypertension [12], and functional gastrointestinal disorders [13]. Clarifying underlying factors and potential consequences of the CAR might help to better understand its often ambiguous links with a variety of health conditions. Two recent longitudinal studies found that a greater CAR is a risk factor for peritraumatic dissociation and acute stress disorder [14], and for major depression [15]. Since the earliest observations of associations of the CAR with psychosocial factors, researchers have repeatedly speculated about functions of the CAR. Uncovering functions of the CAR would serve two goals. First, it might provide an explanation why the CAR has been preserved, and, second, it might help to elucidate biopsychosocial mechanisms in health conditions associated with dysregulation of the CAR. Probably due to the position of the CAR at the beginning of the human activity phase, a recurrent theme has emphasized the potential role of the CAR in dealing with daily life demands within the upcoming day. In the following, this is referred to as the CAR anticipation hypothesis. Despite various reiterations of this hypothesis and some largely circumstantial evidence, a systematic test is still outstanding. In the following we will review history and varieties of the CAR anticipation hypothesis, provide a summary of the core claims, and pr (...truncated)


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Daniel J. Powell, Wolff Schlotz. Daily Life Stress and the Cortisol Awakening Response: Testing the Anticipation Hypothesis, PLOS ONE, 2012, 12, DOI: 10.1371/journal.pone.0052067