Importance: Meditation, yoga, guided imagery, and progressive relaxation have been widely promoted as complementary approaches for health and wellbeing in the United States. However, the extent of growth in these complementary practices over the past 20 years and their use by diverse sociodemographic and health subgroups remains unclear. This knowledge gap could lead to misestimations regarding the applicability and safety of these practices in different settings, impacting public health planning and clinical healthcare decisions.Objective: To assess the prevalence and 20-year trends of meditation, yoga, and guided imagery/progressive relaxation use in US adults between 2002-2022.Design and Setting: We conducted a population-weighted analysis across 5 cycles of the National Health Interview Survey (NHIS) Complementary and Alternative Medicine (CAM) supplement. Participants: Participants were probabilistically sampled to represent the US adult population per census data.Main Outcomes and Measures: We estimated use prevalence and trends for mediation, yoga, and guided imagery/progressive relaxation along with associated sociodemographic and health characteristics. Results: The study included 134,959 participants (M=49.39 years, SD=18.4, 55.4% female). The overall use of meditation (18.3%, 60.53 million), yoga (16.8%, 55.78 million) and guided imagery/progressive relaxation (6.7%, 22.22 million) increased significantly from 2002 to 2022. Growth has been consistent across most sociodemographic and health strata, however traditionally privileged groups, and users of ‘Other’ race or with mental health concerns were overrepresented across practices in 2022. Meditation use accelerated over time for 65+ year olds and less educated subgroups.Conclusions and Relevance: Meditation and yoga have grown in popularity 2-3-fold over the past 20 years and were used by approximately 1 in 5 or 6 Americans respectively in 2022. Growth has been significantly faster among some underrepresented sociodemographic subgroups, but privileged and healthier groups remain overrepresented. There are indications of CAM practices being used to address unmet mental health needs among less educated, Indigenous, and older Americans. Public health officials and health professionals should be mindful of the extensive use of these practices in service and treatment planning and consider their risks and benefits. Further research is needed to understand for whom these practices are most helpful and when other interventions are needed.