Urban, who judged multiple seasons of American Idol on Fox, won Video of the Year, Male Video of the Year, Collaborative Video of the Year, and Social Superstar.
In the Video of the Year category, Urban's "Blue Ain't Your Color" defeated Underwood with "Church Bells," Artists of Then, Now & Forever with "Forever Country," Cole Swindell with "Middle of a Memory," Florida Georgia Line with "H.O.L.Y," and Miranda Lambert with "Vice."
For Male Video of the Year, Urban's competition was Shelton with "Came Here to Forget," Eric Church with "Record Year," Jason Aldean with Lights Come On, Luke Bryan with "Huntin', Fishin' and Lovin' Every Day," and Rhett with "Star of the Show." Urban was once again nominated for this award thanks to his song "Blue Ain't Your Color."
Urban and Underwood, who won the fourth season of American Idol, won the award for Collaborative Video of the Year with their song "The Fighter."
The duo beat the following nominees for the honor: Artists Then, Now & Forever with "Forever Country," Chris Young featuring Vince Gill with "Sober Saturday Night," Dierks Bentley and Elle King with "Different for Girls," Florida Georgia Line featuring Tim McGraw with "May We All," and Kenny Chesney featuring Pink with "Setting the World on Fire."
Urban was also crowned Social Superstar after defeating Jake Owen, Kelsea Ballerini, Alaina, and Rhett in this category.
Underwood also won Female Video of the Year for "Church Bells." She edged out Ballerini's "Peter Pan," Alaina's "Road Less Traveled," Maren Morris' "80s Mercedes," and Reba McEntire's "Back to God" for the win.
Jason Derulo shockingly won a CMT award given he is a pop sensation. The former So You Think You Can Dance judge, along with Luke Bryan, won the award for CMT Performance of the Year thanks to their onstage performance of "Want to Want Me" from CMT Crossroads.
And last but not least, Alaina -- who finished as the runner-up on American Idol's tenth season behind Scotty McCreery -- won Breakthrough Video of the Year for her song "Road Less Traveled."
Alaina defeated the following nominees in this category: Brett Young with "In Case You Didn't Know," Jon Pardi with "Dirt on My Boots," Kane Brown with "Used to Love You Sober," Luke Combs with "Hurricane," and Season 2 The Voice contestant RaeLynn with "Love Triangle."
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Alaina nearly broke down into tears when she accepted this award, as it was clearly an emotional moment for her as well as a dream come true.
"I'm not good at this, I don't know what to do," Alaina, 22, said. "Reba McEntire just gave me an award, so that's pretty crazy!"
After saying "thank you" to her manager and fans, Alaina -- who admitted she was "so nervous" -- thanked Jesus.
"Sorry God, that should've come first!" the country singer quipped. "All of these people up here that I've watched get awards every year -- you guys inspire me."