Goals in bipolar I disorder: Big dreams predict more mania

Bipolar I disorder (BD) is related to overly valued and ambitious goal setting. The purpose of this study was to assess whether people with BD would express highly ambitious goals and show greater arousal when asked to describe their goals, and whether indices of ambition and arousal during goal narratives would predict follow-up symptom severity. Fifty-two individuals diagnosed with BD I per the SCID, followed until remission, and 49 well-matched controls were asked to imagine and describe goals coming true. Heart rate and skin response responses were gathered as indices of sympathetic arousal. Praat analyses were used to code vocal parameters associated with arousal during goal discussions. At 6-month follow-up, the BD group completed standardized symptom severity interviews. Diagnostic groups did not differ significantly on arousal indices during goal discussion. The BD group described goals that were rated objectively as more difficult to achieve, and these more ambitious goal descriptions predicted increases in manic symptoms over time. Implications for clinical interventions are discussed.