Table 1 The components of the stepped intervention

Intervention 1: Care counselling (delivered in 1 home visit/initial telephone contact and ≥ 2 follow-up phone calls by licenced care counsellors)

 1. Caregiver assessment: reflecting the actual caregiving situation with burdensome aspects as well as areas of caregiving mastery, priority setting for the counselling.

 2. Problem-solving: facilitating a positive problem-orientation, guided problem-solving, solution implementation, evaluation, and adaption if necessary (e.g. goal, solution, implementation plan).

 3. Information: according to the national care counselling guidelines (e.g. advise on services and long-term care insurance benefits, care planning, caregiver trainings, compatibility of caregiving and work).

Intervention 2: Cognitive behavioural therapy (delivered in 12 telephone contacts by psychotherapists)

 1. Basic elements: creating therapeutic alliance, individual goal setting, problem analyses, resource activation, handling conflicts and crises.

 2. Psychoeducation: information provision on disease related aspects (e.g. dementia) and caregiving to improve coping with caregiving (e.g. better acceptance of care recipient’s chronic condition).

 3. Changing dysfunctional cognitions: developing alternative and helpful cognitions (e.g. through Socratic dialogue, guided discovery) and their implementation in daily life.

 4. Dealing with challenging behaviour of the care recipient: strengthening problem-solving abilities through problem and behaviour analysis and problem-solving training.

 5. Stress-management and emotion regulation: facilitating acceptance of negative emotions (e.g. anger) as normal and adaptive self-reflection from a self-distanced perspective, developing emotion-regulation strategies, working on general levels of tension and stress.

 6. Self-care and value-based activities: understanding the importance of positive activities in managing mood (e.g. with a weekly diary), developing, planning, and implementing health-promoting activities in everyday life, coping with feelings like guilt as barriers for self-care (e.g. through acceptance).

 7. Coping with change, grief, and loss: discussing experiences of loss and facilitating emotion-based strategies and acceptance to cope with changes caused by the care recipient’s chronic condition (e.g. changes in the relationship with the care recipient, social isolation because friends have pulled back or lack of time to spend with relatives or friends)

 8. Informal and professional support: discussing possibilities of assistance and help by friends, relatives, and volunteers as well as professional services, overcoming possible barriers for accepting help (e.g. feelings of guilt) with CBT strategies like cognitive restructuring.

 9. Limits of caregiving: identifying boundaries and personal limits to what can be provided at home (e.g. when caregiver stress leads to abusive behaviour, violence by the care recipient), preparing the transition from home care to formal care (e.g. nursing home).

 10. Evaluation: summarizing achieved changes and goals, discussing plans and possible next steps.