The affective-neural triage scale: Development and validation of a mechanistically informed psychometric tool for personalized psychotherapy allocation

Traditional diagnostic systems often provide limited guidance for psychotherapy selection, failing to adequately capture neurobiological heterogeneity. This underscores the critical need for mechanistically grounded assessment tools that link symptoms to distinct affective circuits. The present study psychometrically validates an adapted affective-neural triage scale (ANTS), a brief instrument designed to infer subcortical affective and cortical regulatory circuit activation for treatment matching. Unlike existing scales that merely quantify symptom burden, the ANTS framework directly links phenomenology to known brain dynamics. Utilizing a large public personality dataset (n = 19,719), exploratory and confirmatory factor analyses interpreted higher-order traits as conceptual manifestations of fundamental primary affective systems. Neural targets were validated through meta-analytic and external functional magnetic resonance imaging evidence. Results confirmed a robust five-factor solution with excellent model fit (comparative fit index = 0.95; root mean square error of approximation = 0.04), demonstrating psychometric soundness. This adapted framework provides a foundation for transdiagnostic, neuroaffective psychotherapy triage, enabling clinicians to infer circuit dysregulation and select mechanistic interventions. Future work will assess clinical utility, longitudinal responsiveness, and digital integration.