Sure, there might be many more higher difficulties than this one, but it's good to get some perspective. I'm playing on New Game +5 now, and that's a fair bit harder than the base difficulty even before we start thinking about stuff like more durable enemies, curses, shops, potions, and general slants toward "slightly more low-roll-yness".
Haven't commentated a run with the Watcher in a while, so let's join her and see what she's up to today. There's a lot of interesting ideas in her card pool that I haven't gotten around to using yet.