Surrounding rock properties and occurrence stability of a coal seam roof are prerequisites for ensuring the safe and efficient operation of mines. In this study, the mechanisms and control of weakened water-rich roadway roof slabs were investigated regarding the engineering background of water-rich roadway roof slab destabilization in a coal mine in the western Qingyang mining area. The spatial and temporal evolution law of rock deformation and damage of such roadways during excavation were determined through field measurements. First, we tested the strength of the roof slab surrounding rock in water-rich roadways with different water contents and concluded that the primary and excavation-disturbing fissures of the coal-sedimentary rock body are the external conditions for the occurrence of water–rock interaction in water-rich coal seam roadways. Moreover, the rock mechanical damage phenomenon exhibited by clay minerals in contact with water is the key factor leading to the destabilization of the water-rich roof slab’s surrounding rock. Second, a technical approach for controlling the stability of the surrounding rock by adjusting the form of the roadway section and optimizing the support parameters was proposed, and the distribution law of the surrounding rock stress field and displacement field of each section was revealed via numerical calculation. It is considered that adjustment of the stress and displacement control of the surrounding rock of the roadway is more favorable for the straight wall circular arch section. Based on the results of the sensitive orthogonal numerical simulation test, the technical parameters and scheme of the roadway support optimization were proposed. Finally, the research results were applied in the field, and the deformations of the top and bottom slab and the two ribs of the roadway after optimizing the section and support parameters were calculated as 61% and 34% lower, respectively, than those before optimization, indicating that the proposed approach can effectively control the deformation of the water-rich roadway’s surrounding rock and achieve more economic and effective stability control of this type of roadway. The research results provide new ideas and methods for controlling the surrounding rock of water-rich soft rock roadways in the western mining areas of China, which has broad application value and prospects.