Only through the amplification provided by the affect system does anything acheive conciousness. The energy to "pay attention" is provided by affect. Ideally it is Interest/Excitement, though any affect may amplify a mental process or construct enough for it to acheive conciousness. The affect shame tends to be very cognitively disorienting, what I have called "the brain blush" or "cognitive butterfingers". When we see those rarer cases of "ADD" that seem to respond extremely well to an SSRI, shame was probably playing a major role in the disorganization of attention.
The understanding of the role of the affects in organizing attention does not change our combined approach, it merely informs us what our meds and therapeutic interactions are actually doing. For instance, stimulants such as methylphenidate appear to both enhance Interest/Excitement and diminish Shame/Humiliation, thus their great utility in ADD.