Confessions

There are five Acts, or Confessions, in Darkest Dungeon II; the player chooses which Confession to play at the beginning of each run. The choice of Confession affects various gameplay mechanics, including:
 * The final boss
 * The number and choice of Regions in the run
 * Ordainment chance and effects
 * Flame effects
 * Altar buffs
 * Bounty Hunter appearance chance

Certain enemies receive buffs in later Acts, and in general the later the Act is, the more difficult the game becomes.

Denial
As an introduction to the game, the first Confession has a number of unique mechanics:
 * The run only traverses two Regions, The Sprawl and The Tangle, in either order. The Sluice is unavailable.
 * No Boss Trophy is required to enter The Mountain.
 * Ordainment effects are weaker.

Final Boss
The Shackles of Denial

Resentment
From the second Confession onwards:
 * The run must traverse three Regions between The Valley and The Mountain. All Regions, including the Sluice, may appear.
 * A Boss Trophy (strangely, both The Lost Crusade trophies count) is required to enter The Mountain.

Final Boss
Seething Sigh

Obsession
From the third Confession onwards:
 * The Exemplar will appear at the Oblivion's Rampart at the end of the final region before The Mountain.
 * Cultists will receive various buffs.

Final Boss
Focused Fault

Final Boss
Ravenous Reach

Final Boss
Body of Work