New Year’s Resolutions and Bipolar Disorder: Insights from Jo Hughes, DSMc, PA-C, CAQ-PSYCH

With the new year beginning, many patients may be looking to set goals or crafting a New Year’s resolution. Individuals with bipolar disorder might face a different experience in goal setting and achievement towards this end. To discuss more about how clinicians can support patients with bipolar disorder and their potential goals for the new year, Psychiatric Times sat down with Jo Hughes, DSMc, PA-C, CAQ-PSYCH.

Psychiatric Times: Why might patients with bipolar disorder have a unique experience in creating or adhering to large goals such as New Year’s resolutions?

Jo Hughes, DSMc, PA-C, CAQ-PSYCH: Patients living with bipolar disorder often experience shifts in motivation, confidence, and drive that change depending on whether they are trending toward depression, feeling more stable or moving into hypomania or mania. Those mood states really do shape how goals are set, and how realistic those goals feel in the moment. When someone is heading into a hypomanic or manic phase, they may feel unusually energized and optimistic, so goals can quickly grow bigger than what is actually workable. When depression settles in, the very same goals that once felt meaningful or doable can suddenly feel overwhelming or completely out of reach.^1,2

From a neurobiological perspective, affects the brain’s reward system, especially the dopamine pathways that help us decide what feels important and worth pursuing. These pathways run through areas like the frontal cortex and the striatum, which work together to keep our motivation, judgment and follow-through in balance. When that system is dysregulated, as it often is in bipolar disorder, rewards and goals can feel more high stakes during elevated mood states, making it much harder to sustain effort or stay on track when mood or energy drops. So the brain is essentially giving different signals depending on the state someone is in and that shift can strongly shape how goals are experienced and acted on.³

PT: How can clinicians help patients with bipolar disorder manage expectations around New Year’s resolutions?

Dr Hughes: Clinicians can really help patients by shifting the way we talk about goals. Treating goals as flexible, values-based experiments rather than hard-and-fast resolutions takes the pressure off and helps patients move away from all-or-nothing thinking, especially when symptoms or energy levels naturally ebb and flow. It also reduces the shame that can creep in when progress gets disrupted, because the expectation is to learn what works and to adjust along the way.⁴

Giving patients clear, compassionate psychoeducation about how hypomania can inflate expectations and how depression can chip away at confidence helps them understand that these shifts are part of living with bipolar disorder rather than a personal shortcoming.⁵ When patients can name what is happening, it becomes much easier to step away from self-blame and start shaping goals that flex with their mood instead of working against it.

In the clinical setting, it is helpful to frame it as: “Your goals do not have to be perfect or permanent. Let’s make your goals attainable for any and all mood states.” This flexible, illness-aware approach has been shown to support better stability over time, with psychoeducation interventions linked to lower relapse rates and improved day-to-day functioning for people living with bipolar disorder.⁶

PT: What strategies can clinicians use to help patients with bipolar disorder create and plan goals for the new year?

Dr Hughes: I am a big advocate for evidence-based goal-setting strategies as they prioritize scalability, structure, and mood awareness:

• Mood-state–neutral goals that remain feasible during euthymia and lower-energy states
• Tiered goals (minimum, target and stretch versions)
• Process-based goals (behaviors) rather than outcome-based goals
• Integration with mood and sleep monitoring
• Short planning intervals (for example, 2–4 weeks rather than a full year)

Smaller, repeatable goals can lower stress reactivity, create a steadier rhythm, and support overall mood stability.^7,8 When goals become overly ambitious, the risk of manic symptom escalation increases.⁹ The above strategies give patients a steadier foundation, helping them set goals that match their mood state and keep them anchored rather than pushed into overwhelm or escalation.

PT: What are the most common goals or resolutions discussed by patients with bipolar disorder?

Dr Hughes: Clinicians frequently hear goals related to:

• Sleep regularity
• Physical health and weight management
• Financial control and reduced impulsive spending
• Substance use reduction
• Relationship repair or boundary setting
• Productivity
• Career advancement

While these goals are reasonable, they can become problematic when they are pursued with too much urgency or rigidity, something we often see when someone is shifting into a hypomanic state.¹

Sleep-related goals in particular matter a great deal, because sleep disruption is both a trigger for mood episodes and a consequence of them. When sleep starts to slide, everything else becomes harder to regulate.¹⁰

PT: How might clinicians help patients with bipolar disorder navigate the holidays and the New Year?

Dr Hughes: The holiday season introduces multiple destabilizing factors: changes in routine, shifts in sleep and circadian rhythms, more opportunities for alcohol use, social stress, and all the emotional expectations that come with this time of year. Clinicians can proactively reduce risk by:

• Identifying individual holiday triggers in advance
• Reinforcing consistent sleep and medication schedules
• Encouraging limits on social and financial overextension
• Discussing alcohol and substance use openly
• Planning post-holiday recovery time
• Reviewing early warning signs of mood changes

Framing January as a reset rather than a performance evaluation helps patients avoid self-criticism and reduces relapse risk.¹¹ This is especially important because disruptions in circadian rhythms are strongly associated with mood episode recurrence in bipolar disorder, making holiday planning a key preventative intervention.¹²

Dr Hughes is the clinical director, managing partner and founder of Piedmont Partners for Mental Health, PLLC. She is a psychiatric certified physician associate with experience in emergency medicine and psychiatry for over 10 years.

References

1. Johnson SL. Mania and dysregulation in goal pursuit. Clin Psych Rev. 2005;25(2):241–262.

2. Johnson SL, Edge MD, Holmes MK, et al. The behavioral activation system and mania. Ann Rev Clin Psych. 2012;8:243–267.

3. Alloy LB, Nusslock R, Boland EM. The development and course of bipolar spectrum disorders: An integrated reward and circadian rhythm dysregulation model. Ann Rev Clin Psych. 2015;11:213–250.

4. Mansell W, Morrison AP, Reid G, et al. The interpretation of, and response to, changes in internal states: an integrative cognitive model of mood swings in bipolar disorder. Behav Cogn Psychother. 2007;35(5), 515–539.

5. Colom F, Vieta E. Psychoeducation Manual for Bipolar Disorder. Cambridge University Press; 2004.

6. Colom F, Vieta E, Martínez-Arán A, et al. A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission. Arch Gen Psych. 2003;60(4):402–407.

7. Lejuez CW, Hopko DR, Acierno R, et al. Ten year revision of the brief behavioral activation treatment for depression. Behav Mod. 2011;35(2), 111–161.

8. Miklowitz DJ. Adjunctive psychotherapy for bipolar disorder: state of the evidence. Am J Psychiatry. 2008;165(11):1408–1419.

9. Johnson SL, Eisner LR, Carver CS. Elevated expectations among persons diagnosed with bipolar disorder. British J Clin Psych. 2008;47(2):217–222.

10. Harvey AG. Sleep and circadian rhythms in bipolar disorder: Seeking synchrony, harmony, and regulation. Am J Psychiatry. 2008;165(7):820–829.

11. Miklowitz DJ, Scott J. Psychosocial treatments for bipolar disorder: Cost-effectiveness, mediating mechanisms, and future directions. Bipolar Dis. 2009;11(Suppl. 2), 110–122.

12. Frank E, Kupfer DJ, Thase ME, et al. Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder. Arch Gen Psych. 2005;62(9):996–1004.